A welcome compromise on insurance companies covering autism treatments

Parents of autistic children have many things in common, and one most certainly is a shared frustration with attempts to get insurance coverage for Applied Behavior Analysis, a treatment shown to be helpful but very expensive at $4,000 a month.

Now, thanks to a bill sponsored by state Sen. Tom Apodaca, a Republican from Hendersonville, insurance companies will have to cover the expense for families up to $40,000 a year. Unfortunately, the legislation can’t cover those dependent on Medicaid, the federal-state program for the poor and disabled. There are some other gaps for people with certain types of insurance.

This coverage is set to go into effect July 1. All state-regulated plans will be required to cover Applied Behavior Analysis, or ABA, and other treatments.

Autism is a mysterious malady with a broad spectrum of variations and degrees of intensity. It involves children’s limitations on communication and sometimes aggressive behavior. Insurance companies, notably Blue Cross and Blue Shield of North Carolina, have recognized that ABA is a valid and, according to many parents, helpful treatment. Once insurers were willing to compromise, Apodaca was able to make a good push with his legislative colleagues. Former House Speaker Thom Tillis, now a U.S. senator, also had backed coverage.

Apodaca, in negotiating with insurers, said he recognized their costs, but said, “We don’t need to put anybody out of business, but we do need to cover the families.”

Treatments used under ABA include using repetitive exercises to help build communication. It is intense and requires a lot of one-on-one attention. Getting a young patient to say a sentence can be considered a major triumph. Then it’s on to actual conversations.

There are other examples of better behavior from autistic children who have had trouble with basic skills such as bathing and dressing themselves. And ABA delivers improvement as well in reducing aggression seen in some autistic children manifesting itself as biting or shoving.

It’s important to note that those with autism don’t all exhibit exactly the same behavior or the same degrees of that behavior. But there have been advancements made in addressing the challenges that come with autism in all its forms.

Insurance, though, has been a tricky and frustrating thing for many parents, including one interviewed by The News & Observer’s Colin Campbell. The mother of an autistic daughter said she and her husband have had to get financial help from family members to get the kind of care that will help her answer the challenges of her autism.

For them, and now for thousands of others, the possibilities of having insurance may give good reason for hope.