Discussing Autism

When we went to visit our Pediatrician last week because AJ has bronchitis I asked her about the new Autism Screening and what she thought about it. Her response was that they had been doing it for years…so why come up with a new plan?

I guess it is good we go to a good doctor (and I originally thought she was a pain in the neck because she did not agree with our biomedical treatments). She did, however, praise me for how far he has come in the last year. She said his progress is absolutely amazing and his height growth in the last month (one inch) is astounding. So, I have to assume that in the back of her mind she (somewhat) agrees with the biomedical approach we took.

But other doctors disagree with the new autism plan. According to the American Medical News, doctors are widely praising the new guidelines that call for the screening of young patients but the financial realities are a problem.

Doctors are citing billing codes as a factor for NOT screening children for autism.

Are you kidding me?

“We need to be able to be paid for the extra time and extra case management services. This difficulty discourages many people from wanting to take care of these children,” said Dr. Dveirin, who is president of AAP’s Arizona chapter but was speaking on his own behalf.

Because insurance does not may for most autism services parents will have to pay out of pocket for most expenses. Several states are starting to cover some medical expenses but it is very limited.

South Carolina will be one of the first states to institute state mandated autism coverage (starting June 1, 2008) thanks to a group of three moms who fought the system.

With monthly treatments that can reach up to $5000 health care can become a burden and although my son does not have the autistic label…I know the health care burdens as well. Keywords such as sensory, oral motor, dyspraxia, apraxia, developmental delay send claims right back to us…Sorry, your responsibility.

In September, Governor Edward G. Rendell urged Pennsylvania residents and voters to evaluate insurance for children with autism and the Autism Bulletin Blog has gone so far as to outline where services are covered.

There are 17 States that require some insurance coverage including California and Illinois (as part of mental health coverage). Currently, Illinois law requires insurers to cover autism-related services as they would a mental illness, according to a recent Connecticut legislative study.

My issue is that when it comes to occupational therapy, physical therapy, and speech therapy services are not covered because many of MY son’s issues are actually labeled as sensory integration or developmental delay, not under autism or a mental illness (mostly because he does not have that label).

But, even if her were to have that specific label OT is needed because of sensory integration and therefore the insurance company can deny this, as they will not cover OT for sensory integration.

Nice loophole, eh?

Right now 17 states cover autism insurance by law but insurance companies often “drag their feet” on payment or avoid it by questioning codes, qualifications, and treatment.

This happened to us when we sought speech therapy for AJ when he first joined our family. AJ was not able to move his mouth muscles to chew, speak, or swallow. We found a speech therapist trained in oral motor therapy to help us teach AJ to move his mouth. Unfortunately, we uncovered his severe sensory integration issues and after a few months of speech therapy we switch over to occupational therapy for sensory integration.

The insurance company did not see a need for a 2 year old to be in intensive speech therapy (because he would eventually learn to talk, right? We needed him to be able to eat.) and the billing codes our ST had originally used did not “sit right” with them. Ultimately we had over $18,000 in therapy that they had already paid. They were asking for it back.

Well, because they had never requested a pre-authorization and they had already paid for the speech our lawyer said that we were not liable for the bill. And they never came after the money. (Thank goodness)

For specific autism billing codes and developmental delays and how to help you and your doctors, therapists, etc. code documents go to Insurance Help for Autism. You can also head to TACA Now for great information on how to file insurance claims.

Portions of this post are cross posted from an article previously written at Chicago Moms Blog.

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