Autism insurance coverage problems given airing

TRENTON – At today’s Assembly Financial Institutions Committee hearing, Chairman Gary Schaer, (D-36), Passaic, said he expects legislation to be written in six months regarding the gaps in autism insurance coverage that are apparently being experienced by many parents of autistic children. 

He described the runaround many of the parents reported to have received from their insurance companies regarding their bills as “egregious.”

Under a state law passed in 2010, the health care providers have a responsibility of providing care for individuals suffering with autism, of which New Jersey has one of the highest rates.

Health insurance companies are required to cover autism treatments deemed medically necessary, including speech and occupational therapy. The treatments are capped at $36,000.

The law, signed by Gov. Jon Corzine, also mandates coverage for behavioral therapy, which includes exercises to help autistic children do everyday activities.

One issue concerned what is known as applied behavior analysis.

Because of the low number of people specializing in it and because a lot of them don’t participate in insurance company networks, parents often experience difficulty finding the level of care for their children they need.

Suzanne Buchanan of Autism New Jersey said part of the problem is that the process of being part of a network is very cumbersome and they generally offer low rates.

Because of the high cost of autism care, many parents are heavily reliant on schools to provide the care, but oftentimes the level of care provided there is insufficient.

Some of the roadblocks with insurance companies have stemmed from wrong medical coding.

What’s ultimately needed are uniform standards and transparent regulations, said attorney Jodi Bauer. Also, the processing of payment claims needs to take place faster, she said.