Tana Bock, Grand Forks, column: N.D. insurers won’t cover autism treatmentsPrivate health insurance plans do not cover applied behavioral analysis and other autism-related services in North Dakota. Some policies list specific exclusions for autism. Instead, parents of children with autism are forced to either pay out-of-pocket for these interventions or give up on getting the best possible therapy for their child.
By: Tana Bock,
By Tana Bock
GRAND FORKS — April is Autism Awareness Month, so I find this an ideal time to convey my concern for the lack of insurance coverage for children with autism in North Dakota.
Autism spectrum disorder is characterized by a range of complex neurodevelopment disorders, social impairments, communication difficulties and restrictive, repetitive and stereotyped patterns of behavior.
The Centers for Disease Control estimates that an average of one in 88 children is known to have an ASD.
A study in 2006 by the Harvard School of Public Health estimated that it costs $3.2 million to take care of an individual with autism over his or her lifetime, and it costs society an estimated $35 billion each year to care for all individuals with autism.
Direct costs include direct medical costs — for instance, physician and outpatient services, prescription medication and behavioral therapies (estimated to cost about $29,000 per person per year).
The indirect costs relate to the value of lost productivity due to the person living with autism and the loss of income by the parents because of decreased work hours or not working at all.
One study estimated that annual indirect costs for autistic individuals and their parents range from $39,000 to nearly $130,000.
Even though there is no current cure for ASDs, with early identification, the family and child have the chance to get the many benefits that may result from early intervention efforts.
Treatment options may include treatment programs such as applied behavior analysis, which is thought to be the treatment of choice.
Other options include educational interventions, complementary and alternative medicine, dietary changes and medications to manage or relieve the symptoms of autism.
But private health insurance plans do not cover applied behavioral analysis and other autism-related services in North Dakota. Some policies list specific exclusions for autism.
So, children with autism have a hard time getting the treatments they need through Medicaid and private health insurance. Instead, their families are forced to either pay out-of-pocket for these interventions or give up on getting the best possible therapy for their child.
Providing children with these evidenced-based options for treatment will result in the child requiring less intensive care in the future.
According to the Council for Affordable Health Insurance, an autism mandate increases the cost of health insurance by about 1 percent to 3 percent.
But this number is significantly less than the substantial savings that could be gained if children get early evidenced-based treatment.
For example, a 1987 study found that early intensive behavioral intervention therapy resulted in a 47 percent success rate of achieving normal intellectual and educational functioning, in contrast to only 2 percent of the control group.
A 1998 study found that the corresponding cost-benefit savings per child with autism are estimated to be about $280,000 from ages 3 to 22 and $2.6 million from ages 3 to 55.
North Dakota is one of seven states that have not pursued legislation in the State Autism Insurance Reform Initiative.
Today, 29 states require insurance companies to cover autism treatment programs.
Eight states have endorsed autism insurance reform bills, and six states are pursuing autism insurance reform in 2012.
The consequences of lack of insurance coverage for ASD treatments falls upon all North Dakota taxpayers, who eventually will have to pay the bill for special education and lifelong care for individuals with ASDs who were not given the chance to benefit from proven evidence-based treatments.
North Dakota no longer can neglect the consequences of not mandating insurance companies to cover the expenses of treatment for ASDs.
The treatment for children with ASDs must be covered by insurance to guarantee the social, physical and developmental goals that these children have the potential to achieve.
North Dakota must take a new look at the State Autism Insurance Reform Initiative when the Legislature next convenes in 2013.
Bock is a graduate student in the family nurse practitioner program at UND.