Ohio Votes For Autism Inclusion: Coverage for ASD!

So as I neared the post office, I was listening to one man’s opinion, and a strong one at that, about how wrong Obama is with his Health Care Reform stance. He was making good arguments, but the chatter in my head pleaded for someone to recognize that regardless of what we did about Health Care Reform, we had to do something. What we are doing isn’t working, am I not the only one who sees this?I had fuel added to my fire about the insurance game when my daughter, who is diagnosed with Autism Spectrum Disorder, had a claim denied when she was 3 years old. She wasn’t speaking at all at the time and her medical doctor kept saying, “Well, some kids just don’t talk until they are 6.” But, I kept pleading something is wrong. She won’t even look at me when I call her name, she doesn’t budge when we make loud noises behind her, something is wrong with my baby… please do something, help her! 

After a lot of persistence, we got doctor orders to rule out hearing loss as the first step. I was relieved and anxious that we would finally see if this was the culprit for her unresponsiveness and lack of speech. The tests came back negative and she was labeled with the diagnosis of “Speech Delay”. Whew, we were relieved that it wasn’t hearing loss, but…

The insurance company said they would not pay for the tests based on the diagnosis. I tried to calmly explain that we thought she was deaf and we were trying to rule that out… I think that was the first time I truly experienced rage. Here I had this non-verbal 3-year-old who was non-responsive to noise, and I was being told it was not medically necessary to check her hearing. The insurance rep even told me that if she had had speech previously and lost it, they would have paid for the testing. See, insurance companies will pay for rehabilitative services, but not habilitative services.

This was insane! I just wanted to help my child, and even though I paid my high premiums each and every month, they weren’t going to help my little girl. Didn’t they understand that the quicker she got help, the less it would cost down the road?

But, yesterday during a commercial break, I started to whoop and holler. I am sure the old woman in the car next to me thought I belonged to the Looney Bin, but I couldn’t contain myself. I was animated, excited, and wanted to express myself.

“I just don’t understand how they get away with it. Why does the law let health insurance companies discriminate against children with autism?”

I couldn’t believe my ears… OH MY GOOD GOD had listened to my pleas!!

“Families are going broke paying for medical services their children desperately need. Cancer is covered. Diabetes is covered. But not autism – even though autism has become more common than most childhood ailments combined.”

Disbelief, Adrenaline, Hope burst through my essence… Something I have personally ranting on about for the past three years was on conservative radio for everyone to hear. This was a monumental moment and I was praising God as I heard the words sponsored by Autism Speaks encouraging Ohioans to call Ohio House Speaker Armond Budish to advocate for our children.

“Speaker of the House Armond Budish has led the effort to end the terrible discrimination against people with autism. The Speaker hopes to leave a legacy of care for all of those who suffer with autism.”

Our children ARE discriminated against, and it is about time the world knew about it!!

“Please call Speaker Budish today and express your support as he defends his autism insurance reform provision in the budget negotiations with the Senate. Call Speaker Budish at (800) 282-0253… that’s (800) 282-0253.”

I called my husband before the commercial was over; he thought we had won the lotto by the way I greeted him. You know, I would take this bill passing over the lotto any day. Money is controlled by those with political power, but my daughter getting the care she needs, the care she deserves has far more value.

Sometimes, I feel disbelief that this is even a topic of negotiation; 1 out of 150 children experience ASD and we have to negotiate whether or not the treatments that run in the tens of thousands, the tests that have comparable price tags, are in the state budget?

“Now is the critical moment for the people of Ohio to speak up in support of individuals with autism and their families,” said Elizabeth Emken, Autism Speaks Vice President of Government Relations. “We urge all Ohioans to call Speaker Budish, a true champion for the autism community, and voice their support for his effort to end insurers’ blatant discrimination against children with autism. Ohio is closer than ever before to join the growing number of states that have passed legislation serving to right this terrible wrong.”

Don’t hesitate to call Speaker Budish today (800) 282-0253!!

Summary of Ohio Autism Insurance Reform Bill:

House Bill 8 – Sponsored by Representative Ted Celeste (D-24) and Representative Nancy Garland (D-20).

Requires private health insurance companies to provide coverage for the diagnosis and treatment of autism spectrum disorder.

Coverage of treatments will be provided when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary.

The bill includes coverage of the following treatments: Diagnosis, Habilitative or rehabilitative care, Pharmacy care, Psychiatric care, Psychological care, Therapeutic care, counseling services, and Applied Behavior Analysis (ABA).

The bill defines “medically necessary” as a services that is based upon evidence; is prescribed, provided, or ordered by a health care professional licensed or certified under Ohio law to prescribe, provide or order autism-related services in accordance with accepted standards of practice; and will or is reasonably expected to do any of the following: prevent the onset of an illness, condition, injury, or disability; reduce or ameliorate the physical, mental, or developmental effects of an illness, condition, injury, or disability; or assist to achieve or maintain maximum functional capacity in performing daily activities, taking into account both the functional capacity of the individual and the functional capacities that are appropriate for individuals of the same age.

The bill applies only to the fully-funded individual and group health plans and multi-employer welfare arrangements governed by state law.