Show me the Funding

I work for state government and I have good health insurance coverage…for the most part.  Except when it comes to getting the insurance company to pay for services rendered due to my son’s autism diagnosis.  What most people do not realize is that insurance companies will not pay for speech, occupational, physical, or behavior therapy if the diagnosis is autism.  They also will not pay for blood and cell tests if the tests are being conducted to determine the types of vitamin supplements a child on the autism spectrum might need due to deficiencies to better help in the development and behavior process.  Of course, they will not pay for any vitamin supplements that are prescribed by a pediatrician either. 

Some of what is covered by insurance companies is mandated by law while other aspects of an insurance policy is the option of the employer if they want it made available to their employees.  There are some companies out there, not many, that do offer insurance coverage to their employees and family members for autism related services.  Recently, a few state governments have passed laws mandating that coverage for autism related treatment and services be offered to all employees who receive health insurance benefits, and other states are starting to consider similar laws. 

Call your insurance company and ask why they do not cover treatment for autism related symptoms, and you will receive various reasons for the exclusion of coverage. Since, there is no known cure for autism any treatment provided is an effort in futility, right?  There are no approved medications that can help reduce the symptoms and behaviors of those living with this incurable disorder either.  The speech and occupational therapy a person with autism needs is deemed as developmental or educational, and can be obtained through a child’s school district by way of Individual Education Plan (IEP). 

Call them a “can response” or just plain bullsh*t, the line you receive from the insurance companies could be easily applied to other health conditions that are covered. Last I checked there was no cure for depression, but there is approved medications and clinical therapy to treat this mental disorder.  Insurance companies do cover the cost for some prescription medications proven to reduce the symptoms of depression and also provide funding to assist with paying for clinical therapy. Similarly, autism may have no cure, but it is treatable and there are many treatments and therapies shown to reduce the symptoms of autism. 

Like many issues we face during the course of our life, money becomes a factor in the decision making process and insurance coverage for the treatment of autism is no exception to this rule.  It can cost thousands of dollars per year to provide some of the treatments necessary to help a person with autism. On the flip side, by not providing services to give these individuals on the autism spectrum an opportunity to improve their abilities will potentially be more expensive when you factor in the government assistance they will need to receive over a lifetime.  The goal is to get individuals on the autism spectrum as best prepared as possible for the opportunity to live independently or semi-independently in order that they are not a constant fixture on the government assistance payroll. 

Personally, I hope that one day our son will be capable of living independently with someone checking on him from time to time to make sure he is getting everything he needs.  Our goal has always been to give him the greatest opportunities for potential success, but there is no telling what his capabilities will be when he becomes an adult.  He may be capable of holding a job, paying his own bills and having his own place to live, with limited assistance from third-parties (social services and government entities).  We need to stop with the attitude that no cure equals no hope for change and improvement, because we as parents have hope for improvement and a better life for our children. 

Stay tuned for “Show me the Funding” Part 2.