RALEIGH — Autism advocates and insurers are locking horns about a bill passed in the North Carolina House that would require insurance companies to cover behavioral therapy for autism. House Bill 498 is now being considered by the Senate.
Applied Behavior Analysis is the most commonly recommended treatment for people diagnosed with autism, and the legislation would require insurers to cover it, among other behavioral therapies, for up to $36,000 a year. People diagnosed with autism before age 8 are eligible for coverage until they are 23.
Lorri Unumb, a vice president of Autism Speaks, wrote a similar law that was passed in South Carolina in 2007 called Ryans Law, named after her 13-year-old son, who has autism.
This is not an alternative treatment; it is mainstream and evidence-based, Unumb said Tuesday at a news conference held as part of a lobbying effort at the legislature.
Amid concerns about implementing Affordable Care Act mandates, insurance companies are wary of additional mandates and contend the therapy is educational, not medical.
Lew Borman, spokesman for Blue Cross and Blue Shield of North Carolina, said the insurer already covers diagnosis and treatment services for people with autism including speech therapy, physical therapy and occupational therapy.
Blue Cross is lobbying against the bill, along with N.C. Farm Bureau and the North Carolina Chamber. Borman said covering the treatments would cost Blue Cross $14 million to $15 million a year.
But parents of children with autism and medical professionals say the therapy is critical in improving the lives of people with autism.
Darryl Marsch, a senior vice president of Winston-Salem-based Krispy Kreme, said his son Harrison was diagnosed with autism at a young age. He was treated with behavioral therapy and now, at 16, is functional and popular at school. Marsch said he was lucky that his job allowed him to pay for therapy but that most parents are not as lucky.
An untreated child with autism will cost society $3.2 million in his or her lifetime, according to a 2007 study published in Pediatrics & Adolescents Medical Journal.
With the dramatic increase in diagnoses of autism in recent years, Marsch said the legislation makes sense in a cost-benefit analysis.
Two weeks ago, the N.C. State Health Plan decided to cover the behavioral therapy for state employees and their families, more than half a million people. The changes were loosely based on the bill, but the state plan increased the age cap to 26 and eliminated the age 8 diagnosis eligibility requirement. This includes people diagnosed with less severe autism which can manifest at middle-school age.
The State Health Plan has led the way, and now the legislature needs to step up, Unumb said.