Thursday, January 1, 2009

BCBS announces benefit - Edmond Sun

Blue Cross announces new autism benefit

James Coburn

The Edmond Sun
EDMOND — Families have lived with increased financial stress because autism has not been covered by private insurance. Now these same families are wanting to learn the details of Blue Cross and Blue Shield of Oklahoma’s announcement this week of an autism benefit.
BCBS stated their benefit to insured groups will become effective next policy year. Benefits are expected to include evaluation and management procedures, speech, physical and occupational therapies without dramatic increases in premiums, according to BCBS. “We applaud Blue Cross Blue Shield’s efforts. It’s a small step in the right direction but it is definitely something that needs to be done,” said Wayne Rohde, whose son Nicholas lives with autism. “But it clearly tells us that while Blue Cross Blue Shield is wanting to do something, the market didn’t drive it there. This is political pressure put on by the parents of children with autism.”
The Edmond Sun contacted BCBS to be provided details of the insurance plan. These details were not made available by press time. Rohde wants to know if there any limitations to age and the frequency of office visits. “Will Applied Behavior Analysis be covered?” Rohde said. “Are there any artificial monetary caps either annual or lifetime? Are there any limitations on medically necessary office visits for occupational therapy and speech therapy?”
Autism is a complex developmental disability that typically appears in children before age 3, according to the Autism Society of America. A complex neurobiological disorder, it impacts areas of the brain responsible for social interaction and communication skills. The Centers for Disease Control announced in 2007 that one in 150 people has autism. One in every 100 boys has autism. Autism is a quiet epidemic growing at a rate of 10-17 percent per year, according to the U.S. Department of Education. Eighty percent of these children are under the age of 14.
Rohde is a staunch supporter of the proposed Nick’s Law, named after his son. Nick’s Law would have provided insurance coverage for the early diagnosis testing of autism and medications until the child becomes 21 years of age. A financial cap would cover $75,000 of behavioral therapy per year.
Early treatment intervention is the best way to prevent taxpayers from picking up the tab for a lifetime of care for these children at a cost of nearly $3.25 million per child, Rohde said. In March, Nick’s Law went to the House Economic Development and Financial Services Committee after Senate approval 39-9. Sen. Clark Jolley and Sen. Todd Lamb, both Edmond Republicans, opposed Nick’s Law.
Nick’s Law was blocked by the House committee’s chairman, Rep. Ron Peterson, R-Broken Arrow, when he denied giving it a hearing. “We’re willing to come to the table. We were denied that opportunity in the House last year,” Rohde said.
State Sen. Jay Paul Gumm, D-Durant, sponsored Nick’s Law and will file the bill again for the 2009 legislative session. Gumm stated in a press release this week that the announcement by BCBS is evidence that Nick’s Law should become Oklahoma’s law.
Rohde said it would be in everyone’s best interest for Blue Cross and Blue Shield of Oklahoma to release the details of its autism benefit package. State lawmakers need the information so they can make an informed decision in the next legislative session, he said. 341-2121, ext. 114

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