Sunday, March 29, 2009

Oklahoma Legislature Conflicts

Many of us advocating for our children, are confronted with some mind numbing and head scratching comments and statements from our legislators.

Here is a list of them:

1. I do not believe that government should intervene into private business and dictate how to operate their business. The problem with that statement is that it is hypocritical at best and very callous and disingenious at worst. The supporters of less government are also big supporters of tort reform. Is that not government intervention?

2. Mandates will cause the cost of insurance to increase and thus, more people will become uninsured. True if you pile a lot of mandates that are not effect now. However, since no mandates have been passed since 2001 and insurance premiums keep rising at a rate of nearly 10%+ each year, something else is causing the increase and it is not mandates.

3. The parents of children with autism should seek the help of non-profits and churches for help, not the government. This response from a business leader that was picked to help the Speaker's initiative for the Health Care Task force clearly illustrates the ignorance of our leaders regarding problems from our citizens.

What needs to be discussed are the following:

1. The Republican Leadership is actually forcing those who have special needs, acute medical needs, and the elderly onto taxpayer funded and state run health care. Is that not socialized medicine. How ironic is that.

2. What is more fiscally conservative? By allowing more people to access medical care now to take care of their medical condition or forcing taxpayers to pick up the tab later when the costs will be higher and the outcomes not as promising?

Wednesday, March 18, 2009

Report on autism prompts complaint in Tulsa

Published: March 19, 2009

Click here to be linked to the Oklahoman article.

A key proponent of legislation to make insurance companies cover children with autism has filed a complaint against the author of a study that shows the cost of such a mandate could increase rates nearly 20 percent.

Wayne Rohde, who has an 11-year-old son with autism, said Wednesday he filed a complaint against Thomas Cummins of Tulsa, who performed the study for the House of Representatives.

Rohde said he filed the complaint with the Actuarial Board for Counseling and Discipline in Washington, claiming Cummins’ report is misleading and he did not take precautions to keep others from misusing his findings. Rohde said he wants Cummins to publicly retract the study’s findings.

"A lot of the rhetoric coming from the leadership of both chambers is that it’s going to cost too much,” Rohde said.

Cummins, who has been doing actuary studies for the Legislature since 1981, said Wednesday he had no comment on Rohde’s complaint.

His study showed the cost of an insurance mandate would lead to at least a 7.8 percent increase in rates for insured Oklahomans. Rohde said other studies have put the increase at 1 percent or less.

House Speaker Chris Benge, R-Tulsa, issued a statement saying Cummins’ work "was conducted by a professional actuary who has worked in the field for more than 35 years. He has also performed actuarial studies for all pension legislation for the House and Senate for over two decades.”

A House committee considered Cummins’ study last month when it took up a bill that would require insurance companies to cover children with autism. The bill failed.

Parents of autistic child file complaint over autism mandate cost analysis

Wednesday, March 18, 2009 - Page updated at 01:28 PM

Parents of autistic child file complaint over autism mandate cost analysis


Associated Press Writer

The parents of an autistic child have filed a complaint against a Tulsa consultant who they allege prepared a bogus analysis of the cost of a proposed autism health insurance coverage mandate in Oklahoma.

The analysis by Thomas E. Cummins, a consulting actuary who has performed actuarial studies for pension legislation for the House and Senate for more than 20 years, was used to help defeat the mandate proposal in a House committee last month and has been cited in debates over autism mandates in other states, including Kansas, Wayne Rohde said Wednesday.

"His work is not independent," Rohde said. "There is a lot of bias to his work. I would love for our Legislature not to use him anymore."

Rohde and his wife, Robyne, have been at the forefront of efforts to pass legislation to require health insurers to cover the diagnosis and treatment of autism, a bioneurological disability that affects communication skills in young children who may also suffer from ailments such as allergies, asthma and epilepsy.

Autism mandates have been passed in about 20 other states, including Texas. But House Republican leaders oppose it and claim it will increase the cost of health insurance. A mandate plan known as Nick's Law, named for the Rohdes' autistic son, was defeated in a House committee on Feb. 3.

Cummins, who testified at the committee hearing, prepared a study for House leaders that said an autism mandate would increase health insurance rates by at least 7.8 percent and possibly as high as 19.8 percent. Other studies, including one by the Oklahoma State and Education Employees Group Insurance Board, say the cost would be 1 percent or less.

"His report cannot be trusted," Wayne Rohde said. "This report is not credible. In no way can it be right."

The Rohdes, of Edmond, filed their complaint on Feb. 19 with the Actuarial Board for Counseling and Discipline in Washington, D.C. Wayne Rohde said the board asked that the complaint be kept confidential but that he decided to make it public in hopes of reviving the autism mandate.

The complaint alleges that Cummins' representation of the likely rate impact of Nick's Law "may defraud children with autism in Oklahoma of an opportunity to obtain a fair hearing of their legislation."

The complaint alleges Cummins' analysis "wrongfully influenced the decisions of members of the Oklahoma House" and is being used by others to misrepresent the likely cost of the autism mandate.

Wayne Rohde demanded that Cummins retract his analysis and correct it.

"I'm hoping that he retracts it publicly," he said.

Reached at his Tulsa office, Cummins said he had not yet responded to the complaint and declined further comment.

House Speaker Chris Benge, R-Tulsa, expressed support for Cummins' report.

"We stand by our study, which was conducted by a professional actuary who has worked in the field for more than 35 years," Benge said.

Autism mandate legislation was passed by the Senate last year but was blocked in the House. Similar legislation was filed in the Senate again this year but was not heard.

Republican House leaders support legislation that would set standards and licensing procedures for health professionals to treat autism. That bill passed the House last month and is pending in the Senate.

Copyright © 2009 The Seattle Times Company

Complaint filed over "Nick's Law" cost analysis

By The Associated Press
Published: March 18, 2009

The parents of an autistic child have filed a complaint over an analysis of the cost of a proposed autism insurance coverage mandate they say is biased and wrong.

Wayne Rohde said Wednesday he and his wife, Robyne, filed the complaint against Thomas E. Cummins of Tulsa. Cummins performed an actuarial study of the autism mandate for the Oklahoma House.

Wayne Rohde says Cummins' study was used to help defeat the mandate called Nick's Law, named for Rohde's autistic son.

Cummins' study says an autism mandate would increase health insurance rates by at least 7.8 percent and possibly as high as 19.8 percent. Other studies, including one by the Oklahoma State and Education Employees Group Insurance Board, say the cost would be 1 percent or less.

Press Conference - Cummins report factually incorrect


March 17, 2009

Contact: Wayne Rohde

(405) 973-7049 (c)

MEDIA ADVISORY: Wayne Rohde to share complaint filed against Thomas Cummins

The Cummins actuary report is factually incorrect and misleading

OKLAHOMA CITY — The Oklahoma House of Representatives received testimony by Mr. Thomas Cummins, MAAA regarding his actuary study on the proposed legislation known as Nick’s Law, autism insurance mandate.

Mr. Cummins violated several of the Actuarial Board for Counseling and Discipline standards as he prepared and presented his study for the House of Representatives, claiming that the cost of Nick’s Law would result in an increase of up to 19.8%.

A complaint filed by Wayne and Robyne Rohde outlines the errors of the study and the bias of the report.

Other actuary studies, produced by members of the American Academy of Actuaries, and other organizations have concluded that Nick’s Law and other similar legislation has a cost of less than 1%.

WHO: Wayne Rohde

WHAT: Mr. Rohde will outline the complaint, review the inaccuracies and bias.

WHERE: Fourth floor press room, Oklahoma State Capitol

WHEN: 11 a.m. March 18, 2009

WHY: The Cummins study along with the press statement from the Speaker’s office have become testimony in other states to defeat legislation similar to Nick’s Law.


Monday, March 16, 2009

Insurance Mandate Introduced Involving Cancer

By Amy Lester, NEWS 9
Posted: March 16, 2009

Click here to read the entire article.

Click here to watch the video

The bill concerning cancer treatments passed the Senate, including 11 republicans.

Senator Ron Justice (R-District 23) says he supports the cancer treatment bill, but chose to vote against Nick's Law.

OKLAHOMA CITY -- A state lawmaker offers a plea after one bill passes the Senate and another bill remains a long shot.

Nick's Law which would force health insurance companies to cover autism therapies died on the second day of session. One lawmaker keeps pushing for it, without much luck.

A bill about cancer has supporters of Nick's Law up in arms.

They're upset because many Republicans oppose Nick's Law since it's an insurance mandate and could force up premiums. The same concerns do not seem to exist, however, when it comes to mandates involving cancer.

"If mandates are bad, this should've been bad as well," said Senator Jay Paul Gumm (D-District 6).

Senator Gumm is frustrated since some Republicans voted "yes" on a bill that forces insurance companies to cover chemotherapy pills, yet they turn their heads when it comes to autism coverage.

"It certainly says that we value this malady more then we value the one your children are suffering from," Senator Gumm said.

Wayne Rohde is also shocked. He spends countless hours at the Capitol fighting for insurance coverage of autism therapy for his son Nick, the bill's namesake, and other kids.

"It gives us a little bit of a glimmer of hope if the Senate can pass an insurance mandate maybe this legislature will see to do the right thing for these children," Rohde said.

Eleven Republicans voted "yes" on the chemotherapy pill mandate, including Senator Ron Justice (R-District 23). He said it could give rural Oklahoma more access to health care.

"They could take the medication orally instead of having to do to a hospital a long ways away," said Senator Justice. "That's why I thought it was important to at least take a look at it."

But, Senator Justice opposes forcing insurance companies to cover therapy for autism.

"I am concerned about mandates, I do not like to put mandates on but, I think you have to look at each individual bill on its own merits," Justice said.

Despite the resistance, the fight for Nick's Law will continue. Supporters believe they'll eventually prevail.

"We're going to be growing in numbers every year and we're gonna be louder and louder, we're not going to go away," Rohde said.

The cancer mandate still has a long road ahead. It must pass through the House and then back to the Senate for final approval.

Republican leadership who voted against the cancer bill said they oppose all insurance mandates, arguing they'll raise the cost of health insurance.

Sunday, March 15, 2009

Autism meeting reveals hope, frustration

By Liz McMahan
Muskogee Phoenix Staff Writer

March 14, 2009 08:24 pm

— Frustration was a common bond shared by parents, grandparents, caregivers and educators attending a community forum on autism Saturday morning.

They are frustrated not just by the difficulties and challenges they face every day in rearing their children, but also with a system that compounds those challenges many times over.

Autism is a brain development disorder that affects as many as one in 150 children, said Christi Kellogg, founder of the Hope Foundation for Children With Autism and Related Disorders, which hosted the forum at the Muskogee First Church of the Nazarene.

Jeff Edwards of Developmental Wings of Sallisaw said the number of children with autism is expected to get progressively larger. He said he recently talked to teachers who said they are seeing an 800 percent increase in the number of children with autism.

Four state representatives attended the session — two Democrats: Mike Brown of Tahlequah and Eric Proctor of Tulsa and two Republicans: Kris Steele of Shawnee and George Faught of Muskogee.

Steele is principal author of a bill that has passed the House that establishes a certification process for therapists working with autistic children.

That is the first step, he said, in getting insurance coverage for the condition. The bill will become effective Nov. 1 if it is signed into law.

He and Faught have opposed “Nick’s Law,” a Senate measure that would provide insurance coverage for services for autistic children.

Faught said the legislation would put an unfair burden on people like himself who don’t have group insurance. It could raise rates for the self-insured an estimated 7 percent to 20 percent, he said.

Brown took issue with the studies that estimated that increase. Other studies have shown private insurance rates would be increase 0.5 percent to 1.5 percent.
Proctor said insurance companies do not want to pay for treatment for autistic children because it would take away from the billions of dollars of profit they make every year.

He called for the state to place controls on insurance companies.
Those attending Saturday’s meeting said they want solutions now — that early intervention has proven to be of great help to autistic children.

Muskogee pre-school teacher Vickie Garrison said she saw great improvements in the 3-year-olds she used to have in her program. But the program has been cut and she now doesn’t get to see the youngsters soon enough or for long enough periods.

To delay helping parents get help with their children will have a long-ranging impact too, said Wayne Rohde, head of the Oklahoma Autism Coalition and father of Nick, the 11-year-old the proposed law is named for.

He quoted a Harvard study (actually per CDC - misquote) that shows 400 children are being diagnosed with autism each year.

“If we can get to them early enough and aggressively enough, almost 50 percent can recover by the time they reach grade school age,” Rohde said.

Those who are older have little chance of improvement(if not diagnosed properly and receiving treatment), he said. The first group of those children will become adults in four years and will be eligible for disability benefits. The Harvard study shows the cost of caring for autistic adults is $3.2 million per child for a lifetime.

Rohde said he shares the same frustration as all those attending Saturday’s meeting. He is especially frustrated in working with the Legislature in trying to get its help.

“We fight the schools, we fight the doctors and now, we’ve got the disrespect of the legislators,” he said.

Reach Liz McMahan at 684-2926 or lmcmahan

Saturday, March 14, 2009

Gumm: The Fight For Autism Insurance

Sen Jay Paul Gumm

Regular readers of my column know I am fighting to help children with autism. The effort has taken the form of “Nick’s Law,” which would require health insurance in Oklahoma to cover autism spectrum disorders. Last year, we enjoyed bipartisan support in the Senate on this issue.

Not everyone supported it, and I understand that, but senators from both parties joined hands to pass “Nick’s Law” in the Senate numerous times. In the House of Representatives, it quickly became partisan, with the majority Republicans denying the bill even a hearing.

This year, House Republicans shot down “Nick’s Law” very quickly – in hopes of washing their hands of a sticky political issue early in the session. Now, it appears Senate Republicans have decided to be as partisan as their House brethren as two separate votes – right down party lines – suggest they fear even discussing the issue.

The first vote was on a bill about the Oklahoma High Risk Insurance Pool. The pool is the “insurer of last resort,” a creation of the Legislature to provide coverage for those Oklahomans who cannot get health insurance elsewhere. It seems a perfect way to provide autism coverage.

I proposed requiring the pool to cover autism consistent with “Nick’s Law.”

The one change I made was to lower the annual cap to $36,000, the same as the Republican-sponsored Louisiana law that requires health insurers in that state to cover autism.

Instead of allowing the amendment to be considered, the author of the bill moved to “advance” the bill beyond the ability to amend. The motion to advance was approved on a staight party-line vote with Republicans voting “yes” and Democrats voting “no.”

The second vote – again, down party lines – was on a bill to create a Health Insurance Mandate Review Task Force. This task force would be horribly tilted in favor of big insurance and against consumers.

Republican legislative leaders would have eight of 10 appointments to the task force. The governor would have two appointments; the state Insurance Commissioner would be the 11th member.

I proposed an amendment to give the governor two more appointments and require they come from the consumer side of the equation. Legislative leaders and big insurance still would have enjoyed a two-to-one advantage on the task force under my amendment.

That wasn’t good enough; the author of that bill moved to advance the measure beyond amendment, which was approved on a partisan vote. Given the composition of the task force, the results it would propose are a foregone conclusion.

There will be other chances to vote on variations of “Nick’s Law” as I refuse to give up on Oklahoma’s children with autism. The question is: Will Republican members – many of whom have voted for “Nick’s Law” in the past – have the courage to vote their conscience or will they cower under pressure from their leadership?

Mandates don’t work against, but for, consumers

By Jeff Raymond
State view
Muskogee Phoenix

March 13, 2009 04:30 pm

— It’s practically an article of faith that mandates to cover specific conditions, drugs and treatments increase costs and lead to a greater number of uninsured.
What’s often overlooked is that mandates may, in the long run, save money.
Oklahoma has required insurers to cover the cost of diabetic testing and treatment since 1996. The cost of covering diabetic supplies pales in comparison to the cost of caring for diabetics who haven’t managed the condition.

Consider breast cancer: A mammogram costs $50 to $150. The average cost of breast cancer treatment is more than $20,000, according to the National Cancer Institute. Catching tumors early saves considerable money later, not to mention women’s lives.
In 2006, according to state Health Department data, 67.7 percent of Oklahoma women over age 40 reported having had a mammogram during the previous two years. In 1996, 59.5 percent reported having had a mammogram during previous two years. In 1988 the number was 42.9 percent.

Required coverage of mammograms has been on the books in Oklahoma since 1988.
The increase in mammography rates has come about because of many factors, including better education and increased availability. But we owe it to ourselves to consider the effect of requiring the procedure to be covered.

Oklahoma’s mandate count, 36, falls in the middle. Requirements range from hearing aids to well child care.

Interestingly, some states that have far more mandates have more affordable insurance and/or a lower rate of uninsured.

Opponents of mandates focus on their aggregate cost. Yet pinning down the cost of mandates is notoriously difficult. Estimates are unreliable, as the wildly varying estimates of the cost of autism coverage have shown.

We should begin looking at mandates as a reflection on the high cost and disappointing quality of health care rather than their cause. If health insurance companies would serve policyholders rather than block the care they seek, average Oklahomans wouldn’t seek redress through the legislative process.

Insurance companies’ routine refusal to cover common-sense medical care, especially cost-saving preventative care, has led to mandates. It’s time for Oklahomans to look at mandates as a way to improve health care for much less cost than ultimately caring for the sick.

The huge shift in political support for mental health parity illustrates this. Many researchers now accept that it’s cheaper to treat someone for mental illness than suffer lost work and productivity.

The National Association of Health Underwriters claims the more groups demand specialized mandates, the more “the train gets a full head of steam” and can’t be stopped. Disease- and condition-specific lobbies will queue up and demand coverage as well.

The organization slips into old scare tactics. With health care premiums for an Oklahoma family increasing by 62 percent from 2000-2007, requiring more in return isn’t asking too much.

Because coming up quickly with tens of thousands of dollars is impossible for most of us, the end result of requiring insurance companies to do less is to shift the cost to taxpayers.

Opponents of mandates argue that nothing is free. They’re right: Someone pays for health care. It’s just a question of whom — taxpayers or insurance companies.

Jeff Raymond is executive director of OKWatchdog in Oklahoma City.
Call it at (405) 824-2382.

Copyright © 1999-2008 cnhi, inc.

Friday, March 13, 2009

Insurance resists obligations to pay

THE PEOPLE SPEAK: Insurance resists obligations to pay

Muskogee Phoenix
March 13, 2009 04:35 pm

— Insurance companies cannot be trusted to make unbiased decisions in deciding to pay a claim as long as they are unregulated.

The degree to which their profit motives drive behavior ranges from slightly sleazy to illegal to immoral are the same motives that drive Oklahoma’s GOP by denying special needs insurance mandates which eat into the profits of Oklahoma’s insurance monopoly and most certainly reduce the amount of PAC money lining the pockets of the GOP.

Insurance companies have a long history of non-payment to providers for services rendered. They know a certain fraction of rejected claims will be written off by the doctor or paid by the patient, which is pure profit for them.

A class-action suit in Connecticut alleged an industry database designed to provide data on “usual, customary and reasonable” charges was manipulated by United Healthcare to underpay physicians for out-of-network services.

Insurers delay/deny authorization for treatments or impose difficult pre-authorization requirements, since a procedure that is not performed is one they don’t have to pay for, which represents increased profits. Insurers are pursuing their own self-interest so their individual bottom line is protected.

The deliberate policy decisions to obstruct, delay and deny payment for services increases profits. Insurance companies are padding the pockets of the Oklahoma’s GOP so they do not have to cover the costs of diagnosing and treating children with autism. Anytime an insurance company must pay a claim, it eats into their precious bottom line and of course Oklahoma’s GOP PAC money.

Robyne Rohde

Copyright © 1999-2008 cnhi, inc.

Forum to seek help for autistic children and their families

Published March 13, 2009

By Keith Purtell
Muskogee Phoenix Staff Writer

Parents of children with autism will get a chance to talk to Oklahoma legislators at a forum Saturday at Muskogee First Church of the Nazarene.

An effort earlier this year to pass a law requiring insurance companies to cover autism did not succeed.

Autism is a life-long developmental disability that impair a person’s ability to communicate and acquire social skills, according to Autism Edu.

Christi Kellogg, founder of the Hope Foundation, said she and other parents organized the forum as a way to open a dialogue.

“This is our way of saying ‘Hey, we’re out here, we want to talk about our issues that are going on with trying to find health care for our kids,’” she said. “Also, we have people who have suggestions about alternative ways that we could fund autism treatments in Oklahoma. So, it’s not just a way to complain about what’s going on, but a way to get with our legislators and say ‘We’ve got some ideas and we want to work together with you and find some way to resolve this health care crisis.’”

Kellogg said parents of autistic children all across the state face huge obstacles in finding and paying for treatment.

“So here we are; we have no solutions as far as our kids go,” she said. “Parents are putting multiple mortgages on their homes just to pay for treatments for their kids, if they can even find treatment. In eastern Oklahoma, you’re lucky to find speech and occupational therapy. Other than that, it’s difficult to even find services and treatments for autism.”

The forum will also be a chance to present alternative ways to fund treatment for autistic children. At least two legislators have confirmed they will attend: Rep. George Faught, R-Muskogee, and Rep. Kris Steele, R-Shawnee.

If you go

WHAT: Autism Legislative Forum.

WHERE: Muskogee First Church of the Nazarene, 2700 E. Peak Blvd.

WHEN: 10 a.m. to noon, Saturday.


Wednesday, March 11, 2009

Utah Autism Advocates pull support for Clay's Law

By James Thalman

Desert News
Published: March 10, 2009

A grass-roots, well-mobilized coalition of parents with autistic children have pulled their support for SB43.

Amendments that have caused the bill to move slowly though the legislative process have all but removed the core reason for bringing to lawmakers attention in the first place, said organizers of the Utah Autism Coalition.

The group was asking for a mandate on some private health insurance companies to cover the cost of in-home, intensive behavior and learning modification for young children.

The latest version of "Clay's Law," named after 8-year-old Clay Whiffen who is apparently autism disorder-free due to the in-home teaching cited in the bill, is at best a shadow of it's original purpose, the boy's mother, Leeann Whiffen, said Tuesday.

"'Clay's Law' no longer exists in this legislative session," Whiffen said. "Our elected officials have failed to act upon the cries for help from their constituents to provide desperately needed treatment for their children, and the pleas of taxpayers for financial relief to the state. (SB43) is now a far cry from the financially and morally responsible bill we created."

The adage that something is better than nothing doesn't apply in this case, she said.

Lawmakers' action and the course of the bill compounds the ongoing damage the bill intended to help rectify. Quick action, such as the training courses mentioned in the bill, was needed from lawmakers because therapy works best for kids under age 9 or 10, according to the coalition.

"The window of opportunity for optimal treatment will likely close for many children who currently have autism across our state while we agonizingly wait for lawmakers to do the right thing," Whiffen said.

The coalition will continue advocating for autism insurance coverage in Utah until it eventually becomes law, she said.

The autism bill was arguably the most rallied-around, most discussed in committee hearings and more divisive among lawmakers than almost any other issue this session.

But the amendments couldn't be helped, lawmakers said. Opponents said their hearts were behind the parents, but the state is behind an economic eight ball, and that means lawmakers are acutely against imposing mandates or anything that adds to medical-care cost shifting.

Money is an issue with the autism bill. The training is apparently working wonders in kids, and that's great, opponents said, but the $30,000 to $50,000 a year price tag is just too high.

As it reads now, the bill would only benefit children not yet born, and only if their parents purchase an insurance policy that covers covering the training before the child is 3 months old.

Autism Speaks, the largest national autism organization, endorses the coalition's withdrawal of support for SB43.

"It's the No. 1 thing we hear from parents: What's more difficult than knowing there's an effective treatment for your children, but you can't afford to offer it to them because it's not covered by insurance?" said Elizabeth Emken, the group's vice president of government relations. "Autism Speaks and the Utah Autism Coalition call on Utah's legislators to join the growing number of states that have ended health-care discrimination against children with autism."


© 2009 Desert News Publishing Company | All rights reserved

Tuesday, March 10, 2009

Patients bear the burden of the insurance industry's drive for profits

by Robyne Rohde

Insurance companies cannot be trusted to make neutral and unbiased decisions in deciding to pay a claim. Not so long as they remain unregulated. The degree to which their profit motives drives behavior range from slightly sleazy to illegal to immoral are the same motives that drive Oklahoma’s GOP by denying Special Needs insurance mandates which eat into the profits of Oklahoma’s insurance monopoly and most certainly reduce the amount of PAC money lining the pockets of the GOP.

Insurance companies have a long history of non-payment to providers for services rendered. One common tactic is to go through the medical record, or the claims submission form and find some minor error or omission and deny payment for the whole claim on the basis of the minor error. The insurance companies know that a certain fraction of rejected claims will simply be written off by the doctor or paid by the patient, which is pure profit for them.

Additionally, insurers will automatically bundle multiple services into a lower single payment, or substitute one service for another, without any justifiable reason beyond the fact that they can. A class-action suit in Connecticut alleged an industry database designed to provide data on "Usual, Customary & Reasonable" charges was manipulated by United Healthcare to underpay physicians for out-of-network services.

The tactics of health insurers have not been limited to the provider side of the equation, patients bear the burden of the insurance industry's drive for profits. They will delay or deny authorization for treatments or impose difficult pre-authorization requirements for documentation and necessity, all in the hopes that a certain fraction of claimants will be deterred by the amount of administrative red tape and simply lose interest and go away. A procedure which is not performed is one they don't have to pay for, which represents increased profits for the health care company. It's important to recognize that this burden increases the cost of health care for everybody, as doctors and their staff have to waste their time dealing with insurers seeking approval (which is often denied anyway). But the insurance companies don't care about this -- why should they? They are private players pursuing their own self-interest by ensuring that their individual bottom line is protected.

There's also good money to be made by denying payment for care already provided! Some particularly egregious practices of retroactively reviewing the applications of patients who develop expensive health problems and rescinding coverage based on minor typographical errors or immaterial omissions is quite common.

These are not the isolated actions of occasional misinformed insurance claims representatives, but the result of deliberate policy decisions. They hire people who are trained to obstruct, delay, and deny payment for services. These same organizations are padding the pockets of the Oklahoma’s GOP so they do not have to cover the costs of diagnosing and treating children with autism. While it has been proven that the cost to the policy holder would be less than 1%, for autism insurance coverage, anytime an insurance company must pay a claim, eats into their precious bottom line and of course Oklahoma’s GOP PAC money.

OK Senate backs Insurance Analysis

Coverage mandates are at issue

Published: March 10, 2009
The Oklahoman

Click here to link to the article.

A task force would review coverage requirements placed on insurance companies in Oklahoma under a measure passed by the Senate on Monday."

A task force would review coverage requirements placed on insurance companies in Oklahoma under a measure passed by the Senate on Monday.

Senate Bill 822 would create a panel to review the 36 mandates that require health insurance companies to pay for the treatment of certain ailments. The task force, made up of members of the insurance community, health care providers and private citizens, would evaluate existing mandates and make recommendations on which should be revised or eliminated, according to the bill filed by Sen. Cliff Branan, R-Oklahoma City.

The bill passed the Senate with a vote along party lines of 25-21. However, the bill does not advance to the House just yet. Both Republican and Democratic members of the Senate asked that it be reconsidered at a later date. All bills must pass out of the Senate by Thursday to be heard in the House.

Discussion about the creation of a task force quickly turned into debate about Nick’s Law, a failed measure to require insurance for autistic children.

Democrats argued the task force would seek to get rid of insurance mandates, including laws that require insurers to cover treatment of serious mental illnesses and breast cancer screenings.

"Mandates exist because people felt like their issues weren’t being addressed,” said Sen. Jay Paul Gumm, D-Durant, who has pushed for autism insurance. "At the end of the day, this is not going to help the people of Oklahoma; it’s going to hurt them. That’s not what I was elected to do.”

Republicans argued that mandates increase the cost of premiums to customers, who sometimes drop coverage because it cost too much. The end result is more people in Oklahoma without coverage.
"Mandates cause premium payers to pay more,” said Sen. Bill Brown, R-Broken Arrow.

Saturday, March 7, 2009

Government again concedes vaccines cause autism


Published March 04, 2009 12:55 pm - The Oklahoma House turned back HB 1312 on the second day of its session this year. The bill, known as 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.

March 4, 2009 March 04, 2009 12:55 pm

The Oklahoma House turned back HB 1312 on the second day of its session this year. The bill, known as 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 have covered $50,000 of behavioral therapy per year without lifetime caps in the House plan.

According to legislative rules any similar bill cannot be introduced for two years.
Legislators may be unaware of a recent announcement by Generation Rescue, a non-profit autism organization related to the cause of autism by vaccines.

Generation Rescue, Jenny McCarthy and Jim Carrey's Los Angeles-based non-profit autism organization, today announced that the United States Government has once again conceded that vaccines cause autism. The announcement comes on the heels of the recently unsealed court case of Bailey Banks vs. HHS.

The ruling states, “The Court found that Bailey would not have suffered this delay but for the administration of the MMR vaccine...a proximate sequence of cause and effect leading inexorably from vaccination to PDD [Autism].”

In a curious and hypocritical method of operation, the mysterious Vaccine Court not only protects vaccine makers from liability but supports a policy that has tripled the number of vaccines given to U.S. children — all after being made aware of the fact that these vaccines do, in fact, cause autism and repeatedly ruling in favor of families with children hurt by their vaccines.

“It was heartbreaking to hear about Bailey’s story, but through this ruling we are gaining the proof we need to open the eyes of the world to the fact that vaccines do, in fact, cause autism,” said Jenny McCarthy, Hollywood actress, autism activist, best-selling author and Generation Rescue board member. “Bailey Banks’ regression into autism after vaccination is the same story I went through with my own son and the same story I have heard from thousands of mothers and fathers around the country. Our hope is that this ruling will influence decision and policy-makers to help the hundreds of thousands of children and families affected by this terrible condition.”

Banks vs. HHS is the second known case where the Vaccine Court could not deny the overwhelming evidence showing vaccines caused a child's autism. The first was the case of Hannah Poling in March of 2008, where the court found in her favor and awarded her family compensation.

Jim Carrey, Hollywood legend and Generation Rescue board member, reacted to the news, “It seems the U.S. government is sending mixed messages by telling the world that vaccines don't cause autism, while, at the same time, they are quietly managing a separate 'vaccine court' that is ruling in favor of affected families and finding that vaccines, in fact, were the cause.

For most of the autism community the question is no longer whether vaccines caused of their child's autism. The question is why is their government only promoting the rulings that are in favor of the vaccine companies.”

Why is a secret court, which no one knows about or understands, quietly paying these families for vaccine injuries and autism?

Deirdre Imus, Generation Rescue board member and founder of the Deirdre Imus Environmental Center for Pediatric Oncology says, “Over the past 20 years, the vaccine court has dispensed close to $2 billion in compensation to families whose children were injured or killed by a vaccine. I am not against vaccines and my own child has been vaccinated. But, I share the growing concerns of many parents questioning the number of vaccines given to children today, some of the toxic ingredients in vaccines, and whether we know enough about the combination risks associated with the multiple vaccines given to children during critical developmental windows.”

To help spread the word of the Banks ruling, Generation Rescue also bought a full-page ads that ran in the USA Today on Feb. 25, 2009, which has a daily circulation of 2,272,815.

Generation Rescue seeks to answer these questions and many more on a daily basis as they fight for the truth and to recover children with autism around the world. To learn more please visit write to

Copyright © 1999-2008 cnhi, inc.

Put autism in high risk pool

Muskogee Phoenix Newspaper

March 07, 2009 04:56 pm

Health insurance priorities are definitely mixed up when it comes to autism.

Recently, all 22 state Democratic senators asked for a cost-savings analysis if a law is passed barring insurance coverage of erectile dysfunction.

The 22 senators are upset, as they should be, that ED often is provided coverage by insurance companies, but families with autistic children were not able to receive coverage for that malady.

In the last two years, supporters pressing for mandatory coverage of autism by insurance companies have not been able to get a bill out of legislative committees because of Republican opposition. The state GOP claim is that the cost of covering autism would increase all premiums significantly.

Without doubt, premiums would increase, but the alternative is autistic children not receiving the care they need or families without coverage taxing the health care system through indigent care. Either way, there is a public cost.

And if it’s important that middle-aged and older men are able to have sex, then it’s definitely important that young children receive treatment that will help them function in society.

The measure passed earlier this year by the Legislature to increase the number of trained autism therapists in the state does nothing to help families if they cannot afford to take their children to the therapists.

Again, as we and others have said before, as long as insurance companies deny coverage for many illnesses, they are managing risk, not providing insurance. They only look for profit, not to provide a service to customers.

If the Legislature cannot force insurance companies to cover autism — and only one has shown a willingness to do that — then we fully support the efforts of Sen. Jay Paul Gumm, D-Durant, to add autism coverage to the state’s High Rsk Insurance Pool.
That is not the ideal situation for Oklahoma families with autistic children, but it’s better than the alternative they face.

Copyright © 1999-2008 cnhi, inc.

Thursday, March 5, 2009

You're OK Oklahoma

The Oklahoma House voted this week 91-1 for HB 1598, the School Protection Act. This bill is about tort reform in the school system. What it really does is it makes it very difficult for parents to hire attorney's to represent them in due process hearings.

Parents of special needs children are always fighting schools with IEP's and other school issues. Due process hearings are very difficult, time consuming, thus requiring legal help to guide us.

Now, with a limitation on the fees and expenses, it will limit all but the very wealthy, in hiring an attorney.

The House did not want Nick's Law, autism insurance coverage, now they want to step on the necks of those same parents, and limit their rights to sue.

You're OK Oklahoma, ya right.

Sunday, March 1, 2009

Dems' agenda is left to the shouting

Sunday, March 01, 2009

Click here to comment on Tulsa World article.

House Democrats promise to make more noise as legislation favored by the in-control Republicans is taken up on the chamber's floor in the next two weeks.

Many bemoan legislation they authored that did not make it out of committees by last week's deadline. In some committees, Democrats didn't speak out against measures they were against.

"The opposition will begin now," said House Democratic leader Danny Morgan of Prague. "What you're going to see from the Democratic caucus is a lot more activity from us on the floor so that the arguments against these pieces of legislation can be heard by the entire body and not a half-dozen committee members.

"I don't know that I've ever seen this caucus quite as invigorated as it is right now. Sometimes failure promotes energy."

House Republican leaders got all their key issues through committees — no surprise as Republicans control the House 61-40, and as a result, all committees.

House Speaker Chris Benge had all his key proposals — including bills promoting the use of alternative fuels through tax breaks and other incentives — passed unanimously out of committees.

"It's been a good, productive, first four weeks," said Benge, R-Tulsa. "We've got a lot of good things going. The budget (shortfall) still is going to be a challenge, of course, but I feel good about things to this point."

Democrats lost their showdown with Republicans over the autism mandate during a committee hearing on the second day of this year's session.

Benge said more study is needed on the cost of mandating coverage.

"We've established a good precedent that you deal with these mandate issues, examine them, analyze them and have a better understanding of the effects on all Oklahomans before you act on them," he said. "We put together a good plan, and I feel it's a step in the right direction to addressing families with autistic children."

Republicans got their proposal on how to deal with children with autism passed out of committee and basically eliminated any chance legislators would consider for the next two years the Democratic-backed idea of requiring insurance companies to cover children with autism.

The House Republican measure, by House Speaker Pro Tem Kris Steele of Shawnee, calls for enacting a licensing process for national board-certified behavioral analysts and expanding state programs that train doctors to diagnose and treat autism.

Still, Morgan said Democrats will try to keep alive the concept of insurance companies being required to cover treatment for children with autism.

"What we're wanting to do is just establish a pattern that if you cover other areas of medical service, then we think that autism ought to be just as important," he said.

Morgan said he's disappointed that two measures he filed didn't get heard by committees: establishing a no-call list for businesses, and prohibiting drivers under the age of 18 from being able to use cell phones while driving. He hopes to find some bills where he can put in some of the language of his proposals.

With House members filing 1,270 bills, 46 joint resolutions, and six concurrent resolutions for consideration this session, it was understood that most would be set aside so essential bills picked by Republican leadership could make their way through the 17 weeks or so legislators are in session. Nearly 400 measures advanced to the House floor, a House spokeswoman said.

Lawsuit reform measures, bills promoting alternative fuels and energy independence, reducing the number of Oklahoma's uninsured, voters being required to show identification, revamping the state medical examiner's office, and modernizing and reforming state government buying practices all passed out of committees and will be up for action on the House floor in the next two weeks.

Other measures by Republicans that passed committees include making English the official language, taking steps to crack down on puppy mills and changing how workers compensation judges are picked.

A proposal by Rep. Jason Murphey, R-Guthrie, to allow faculty members and those who have concealed gun permits along with firearms training to carry concealed weapons on college campuses remained bottled up in committee. Murphey, noting the Senate killed a similar measure, said he may wait until next session to bring out a guns-on-campus bill.