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autism-spectrum-disorder

Unless we have some inside connection to a family that lives with an individual who has an Autism Spectrum Disorder diagnosis we are blissfully unaware of the costs of the care required. Since there has been a continued upsurge in the diagnosis of Autism Spectrum Disorder in children (now about 1 in 68 U.S. children is identified as living with autism spectrum disorder) legislators have become more aware of the gaps in these individuals’ health insurance coverage.

The result : children under the age of 7 with diagnoses of Autism Spectrum Disorder will have their health insurance benefits increased in the state of Georgia beginning with July 1 effective dates. Whether they are covered on individual or group medical insurance plans the improvements will be included when coverage becomes effective or renews after July of this year. Plans can be Affordable Care Act compliant or not, they can be fully insured or have self-funding features, but it appears that within the next twelve months possibly all plans will include the new benefits.

How will families of these children benefit? One of the key provisions is that limits on the number of visits allowed for physical, occupational and speech therapy for the treatment of Autism Spectrum Disorder will be removed. In the past individuals who needed extended therapy were limited to 20 to 30 visits combined for all their ongoing needs. This hardly scratched the surface of the expense these families incurred and barely addressed the financial devastation parents faced when they tried to provide the level of care their loved ones needed.

Although pre-certification and pre-authorization will be required for Applied Behavioral Analysis, there will now be benefits up to $30,000 per year for this treatment. Early identification of Autism Spectrum Disorder and early application of Applied Behavior Analysis can produce meaningful and positive results.

Will this legislative change adequately address all of the medical expenses incurred by children who have this diagnosis? Certainly not, but it addresses these children’s medical expenses in a way that they have not been in the past. Over time other treatments will likely be included, but without an initial change in how the diagnosis is considered there seemed no hope for improvement, until now.