Insurance reform supporters plan move

Edmond Sun, July 8, 2010

EDMOND — An Edmond family who has led the charge for autism insurance reform in the state is planning to move.

Wayne Rohde announced in an e-mail and Facebook e-mail that he, his wife Robyne and their sons, Austin and Nicholas, will move to Minnesota at the end of the month. His youngest son, Nicholas, is the namesake of Nick’s Law, which did not gain final legislative approval a year ago. The law would have mandated that insurance companies cover autism health care costs in Oklahoma, and was the center of a bitter partisan fight at the state Capitol.

“While we are very excited to go to a state that is autism friendly and we will be able to provide the greatest amount of education and medical care for our son Nick, we are saddened to leave Oklahoma and the many friends that we have had the pleasure of meeting and knowing,” Wayne Rohde wrote.

He encouraged those who remain in Oklahoma to continue the pursuit for autism insurance coverage. He cited the 21 other states that now have autism insurance coverage and thanked Sen. Jay Paul Gumm and Rep. Mike Brown for their efforts to pass Nick’s Law.

“Most of these states see insurance coverage for autism and other special needs conditions as a fiscally conservative approach to health care, a true pro-life position, and the morally responsible thing to do,” Rohde wrote.

OK Watchdog Executive Director Jeff Raymond worked with Rohde at the Capitol for insurance reform.

“Through tenacity, a single-minded dedication to his son and force of personality, Wayne Rohde united parents of children with autism and was instrumental in keeping health insurance reform and accountability in the public eye and on lawmakers’ radar year after year,” Raymond said Thursday. “Before I got to know Wayne, I had become cynical about the idea that an average person could bring about meaningful change. Wayne has restored my faith in one’s ability to make a difference. I have no doubt the changes he fought so hard for will reach Oklahoma one day.”

Rohde said he encourages advocates for insurance reform to get to know the bevy of new candidates running for political office this year and to let them know where constituents stand on the issue.

“There is a tidal wave approaching our nation regarding the large numbers of children with autism becoming adults in the next three to four years. Employment, housing, long-term care and many other issues will have to be addressed,” Rohde wrote.

Moving on Up

Want to announce to all of you that my family and I are moving from Edmond to Minnesota at the end of the month. While we are very excited to go to a state that is autism friendly and we will be able to provide the greatest amount of education and medical care for our son Nick, we are saddened to leave Oklahoma and the many friends that we have had the pleasure of meeting and knowing.

The battles at the state capitol for insurance coverage for autism (Nick’s Law) and other medical conditions for our children, teenagers, and adults must go on. We are very proud of the many families and parents that have given so much to move this state forward. We appreciate each and every one of you, for advocating for your kids and other family members, and for never giving up.

“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has” – Margaret Mead

Sen Jay Paul Gumm and Rep Mike Brown will continue the fight for Nick’s Law. These are men of great character and conviction. Help them and follow them. There are now 21 states that have passed similar legislation and with New York waiting for their governor’s signature, that will make 22 states. Most of these states see insurance coverage for autism and other special needs conditions as a fiscally conservative approach to health care, a true pro-life position, and the morally responsible thing to do. Continue that approach at 23rd and Lincoln.

There is an emergence of new candidates running for political office. Seek them out, get to know them, and talk with them. It is your responsibility to let your elected representatives know where you stand.

This state has so far to go but because of your efforts and from others, we have come a long way. There are those who have been advocating for many years prior to our recent efforts in the last 4 to 5 years. They are to be congratulated and honored. Learn from them. And there will be many to come after our efforts. Welcome them, teach them, and encourage them.

“Open your mouth for the mute, for the rights of all the unfortunate. Open your mouth, judge righteously, and defend the rights of the afflicted and needy.” – Proverbs 31:8-9

We had the privilege of working side by side with many of you at the capitol and throughout the state fighting for Nick’s Law, reforming special education in our state, advancing public awareness of autism and special needs, and other issues related to special needs children and adults.

But there is so much more to do. Many of our children will become teenagers very soon and employment opportunities need to be expanded. Many of you are on the forefront of transition services, we thank all of you for your tireless work. There is a tidal wave approaching our nation regarding the large numbers of children with autism becoming adults in the next 3 to 4 years. Employment, housing, long term care, and many other issues will have to be addressed.

“It was once said that the moral test of our society, our government, is how we treat those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.” – Hubert Humphrey

So we say good bye to all of you. Best wishes for you and your families. God Bless.

Sincerely,

Wayne, Robyne, Austin, and Nicholas Rohde

OU autism pilot program shows success

The signs that Blaine Davis wasn't quite like other toddlers came early. Even more than the fact that he didn't play well with others, he lacked the skill to point to what he wanted.

That inability to express his wants and needs meant that he would follow his mother around and cry in frustration.

"He was in his own world,” said his mother, Jennifer Davis.

"He had no way of communicating with us and he would try to communicate by crying and pushing and shoving, not in a mean way, but trying to show us what he wanted.”

But Oklahoma's Early Foundations researchers identified Blaine's autism-type behaviors and got him started in an early intervention program that Steve Davis said has generated unbelievable progress in his son.

One day after Blaine attended the playgroup at a local church, the teachers said he'd told teacher Seth Kastner that he loved him.

"I'd only heard him say, 'I love you,' one other time, that was to me,” Steve Davis said. "Being a parent of a 3-year-old child and not hearing 'I love you' is incredibly difficult.”

Now, Blaine has learned to point, use sign language and even allows his parents to touch him.

The University of Oklahoma Health Sciences Center's pilot project is designed to identify the autism spectrum disorders in toddlers like Blaine.

Like Blaine, one in every 110 children has been diagnosed with the disorders, according to the Centers for Disease Control and Prevention. Researchers found that autism is being reported at higher rates than ever before.

"It's a pretty significant increase in the last 10 years,” Bonnie McBride, principal investigator for the Early Foundations Project, said during a news conference Wednesday at the center.

Though children are often 2 years old by the time their autism is identified, she said the earlier an autistic child is diagnosed the better the outcome.

About the program

The Autism Workforce Initiative is Oklahoma's response to the needs of children, their families and pediatricians.

The initiative features components such as a physician training program, along with the early intervention program for young children suspected of having an autism spectrum disorder.

Children enrolled in the program receive 17 hours per week of help through activities such as play groups, intensive teaching involving behavioral techniques, weekly home visits and monthly parent education nights.

"It's awesome. It's changed our lives, it really has,” Steve Davis said.

Services are provided through Oklahoma's Early Intervention system and the model site serving roughly 10 families in Oklahoma City is funded using federal dollars through the state Department of Education.

Along with developing an intervention model through its pilot site in Oklahoma City, the project is intended to provide outreach support to other communities statewide. The project also is operating in Cleveland and Canadian counties.

The program is offered free to families of all income levels through SoonerStart, the state's early intervention program for infants and toddlers with disabilities and developmental delays.

For more information on the SoonerStart program, call 522-5167 or go to www.okdhs.org/programs andservices/dd/ss.



Read more: http://www.newsok.com/article/3465628?searched=autism&custom_click=search#ixzz0q2FKDK1s

Michigan insurers should cover autism, experts tell senators looking into impact on families

May 24, 2010 • The Rossman Group
YPSILANTI, Mich. – Autism experts and parents said today at the first of four public hearings that more Michigan children with autism will go untreated unless Michigan insurers help cover medically proven therapies that families can’t afford on their own.

“It’s heartbreaking to learn your child has autism, but to find out your insurance company won’t cover treatments that would allow your child to live a fuller, more independent life – that creates such despair, and thousands of Michigan families are feeling that right now,” said Pamela Lemerand, director of the Autism Collaborative Center at Eastern Michigan University.

The center was the site of the first of the bipartisan hearings spearheaded by Sens. Randy Richardville, R-Monroe, and Tupac A. Hunter, D-Detroit. The lawmakers want to know more about the impact of the complex neurobiological condition on the families of the 15,000 children in Michigan who have autism. Autism impairs a person’s ability to communicate, learn and relate to others.

Autism affects one in every 110 children and is the fastest-growing developmental disability in the country, according to the U.S. Centers for Disease Control. It can be effectively treated with early, intensive intervention such as speech, occupational and physical therapies, and behavioral health therapy, but treatment can cost $50,000 annually.

“We need to know firsthand how this devastating condition affects Michigan families," Richardville said. “It's important to explore various options that may represent an opportunity to help those in need and be more efficient with public funds.”

Insurance companies generally do not cover autism treatment, so 19 states have updated their insurance laws to cover it.

It is estimated that early diagnosis and intervention could save Michigan taxpayers lifetime costs of $14 billion for the current population of autistic children. The savings reflect avoided costs for supports such as long-term care and special education.

“If diagnosed and treated early, children with autism can make significant gains that affect their independence and family functioning in many ways,” said Dr. Catherine Lord, director of the University of Michigan Autism and Communication Disorders Center. “Making sure insurance companies cover early treatment just makes good fiscal sense.”

But it’s also a social injustice that needs to be addressed, Lord said. “What other medical condition with known, medically proven interventions is routinely denied coverage?"

A recent study found the state of Texas could save up to $771.5 million in special education costs alone within just the first 10 years of passing autism insurance reform legislation. In Michigan the savings could be $3 billion over the entire school lives (age 3-26) of the 15,000 children with autism.

“Without insurance reform, Michigan taxpayers will continue to be saddled with these costs and Michigan children won’t have access to medically proven therapies that can be life-changing for them and their families,” said Lorri Unumb, senior policy advisor and counsel for Autism Speaks, a Washington, D.C.-based advocacy group that has helped win legislative reforms in several states.

Plans are under way for additional hearings in Detroit, Grand Rapids and Lansing.

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Contact: Sharon Emery 517-896-7075 (c), 517-487-9320 (o)

https://rossmangroup.com/newsitem.php?newsid=464

Call it anything but Autism!

From our friends at Oklahoma Citizen. Click here to access article.

May 24, 2010 - 7:38 pm by ollamok


Parents many times want their disabled child to have a label. Any label will do. Why? So they know what they are dealing with and can start a plan of attack. Or, can finally put a name to what they have faced for so long. They never dreamed that it could force them into being denied basic insurance coverage for an illness or service, but it can.

Please don’t give up. Please continue to fight. There are still ways to get things covered. It takes a lot of endurance but these types of parents to this everyday anyway.

One must first study their insurance plan. What is covered? That is right! Do not look for what is not covered. Read the guide you are given over and over. Become familiar with diagnostic codes. ICD9 coding is used by most insurance companies. Here is a web site that could be of use: http://icd9cm.chrisendres.com/. The way something is coded is the key to getting insurance to pay for the illness or service.

According to an Occupational Therapist, OT, one specific code not to use is 299.00, which is Autism. The code 783.40 is Developmental Delay, another area that insurance has denied often. The code the OT has received the best payment from is 781.3, Praxis or Motor in Coordination. The code has to relate to a medical need, if insurance is to pay.

Through unique circumstances a teacher noted that my son seemed to have a curved spine. My husband and I thought she was wrong. We finally consulted an Orthopedic Surgeon. This resulted in a prescription for Physical Therapy (PT) services, Social Skills Training and Speech Services. He has Scoliosis. The Doctor wrote the Rx for services based on a need to increase spatial body awareness and the diagnosis of Scoliosis, Asperger’s and Dyssemia. Dyssemia is:

“The term comes from the Greek dys (difficulty) and semia (signal). These difficulties go beyond problems with body language and motor skills ‘A classic set of studies by Albert Mehrabian showed that in face-to-face interactions, 55 percent of the emotional meaning of a message is expressed through facial, postural, and gestural means, and 38 percent of the emotional meaning is transmitted through the tone of voice. Only seven percent of the emotional meaning is actually expressed with word’] Dyssemic persons exhibit difficulties with the acquisition and use of nonverbal cues in interpersonal relationships. Dyssemia represents the social dysfunction aspect of Nonverbal Learning Disorder”

The insurance did pay for PT and the other services were not used at that time. Yet, this was a physical reason to write for these services. This Doctor says he sees Scoliosis in children with Autism a lot. This doesn’t mean to take in all children with Autism to an Orthopedic Surgeon. By all means go through the Primary Care Physician (PCP) first.

What this is saying, is there are reasons other than Autism to bill insurance for services. Insurance will pay for these. One has to look at what insurance will pay for and see if their child has these conditions. Does it seem like a game? Well it just might seem like it. If it does, that means you have a chance of winning. If one does try, there is a 50/50 chance of winning, but if one does not try, the result is a loss.

Do you know what a Carve Out Plan is? Do you know what the Birthday Rule is? Do you know if you insurance company is a PPO or an HMO? One can go to www.parenttoparentnys.org and download a book on understanding insurance. Most states will have guide to Medicaid that tells what is covered .There is another web site that has a guide to understanding private insurance, http://www.healthinsuranceinfo.net/. Knowing these terms will help you when you are navigating the insurance network. A Carve Out Plan will not pay for anything that another plan does not pay for if one has two or more plans. The Birthday Rule is where both parents cover a child, the parents’ birthday that comes first is the primary insurance and the other insurance is secondary. My birthday comes first in the year so if I had insurance then mine would be primary and my husband’s would be the secondary.

Other things to bear in mind besides what to call it, believe are not are the geography of where you live. Some states mandate coverage for Autism. If they do cover Autism one might still want to consider calling it something else. What are the caps these states have put on covering Autism? Some have put it at very low. That means the insurance companies win and you lose. These are just things to consider. Just check on what the dollar amount is.

A New York Times articleA Road Map to Help Parents Deal with Financial Burden of Autism, talks about fighting insurance to pay for Autism and stretching the Autism dollar. Of course one needs to keep copies of all records: Explanations of Benefits, Doctors Receipts and other documents such as denial letters. What the article states about stretching the Autism dollar is if the services one gets at school, such as Occupational Therapy(OT), PT and Speech are good, then one can saves the other dollars to pay for out of pockets expenses not covered by insurance where needed.

Insurance often requires one to go all the way through the process of getting a denial and through the appeals process. Sometimes it helps to talk with the State Insurance office. This is not a guarantee and one may have to sue with a lawyer. Remember getting a lawyer may cost money. Even if one does attempt to sue for coverage it is not a given that one will win and sometimes it is good to know when to quit or give up the process. It may cost too much money to pay a lawyer and loose that money too. Please make the best informed decisions for your family.

Playing the insurance game is no fun. I hope this article has brought some strategy to your side. Paying for Autism is a never ending process. Remember call it anything but Autism. Look for something real that your child has, this should be easy. I pray that I have helped you in some way. Bless you for allowing me to share in your trials and blessings.

Autistic kids receive fair treatment with new bill

Sen. Sean Burrage
May 10, 2010
Pryor Daily Times


OKLAHOMA CITY — Starting Nov. 1, parents of children with autism will have greater protection when it comes to more fair treatment by insurance companies. Senate Bill 2045 was approved on bipartisan votes in the Senate and the House and has been approved by the governor. The measure includes language that will make certain health insurance companies cover the same illnesses and medical treatment for children with autism as they do for children who do not have that diagnosis.

To be clear, we are not talking about covering diagnosis and treatment of autism itself, although I believe this is something the state can and should do. We’re specifically talking about families that have insurance, regularly pay their premiums, but when a medical condition affects a child with autism, the insurance company refuses to pay for treatment of that condition, even though the medical problem has nothing to do with autism.

We’ve had literally dozens of families complain that insurance companies had routinely denied claims filed on behalf of their children for illnesses and maladies

completely unrelated to the diagnosis of autism. According to the families, their claims were denied because Oklahoma does not require health insurance policies to cover the diagnosis and treatment of autism, and most insurers will specifically exclude autism.

Another way to put it is this. Two families have the same insurance policy. Both have sons who play a sport. The boy from the first family is hurt playing baseball. The insurance covers the cost of treatment; end of story. But for the second family, if their child is injured playing baseball, the outcome is different. Their medical claims are denied because their son happens to have been diagnosed with autism - even that had nothing at all to do with the getting hurt while playing baseball. With the passage of SB 2045 and the governor’s signature, this lack of insurance parity will no longer be legal in Oklahoma.

Autism continues to be the fastest growing developmental disability in our nation, with as many as one in 110 children impacted by one of the conditions on the autism disorder spectrum. Science still has not determined the cause of autism, but we do know that early diagnosis and access to appropriate therapy and treatment can mean the difference between night and day in helping these children lead fuller lives.

This is the result of hard work and cooperation. The idea began as a bill by Sen. Jay Paul Gumm of Durant, who has pushed for enactment of “Nick’s Law.” While he hasn’t given up on that effort to require coverage for diagnosis and treatment of autism, he came up with this common sense compromise everyone could support, even those who oppose “Nick’s Law.” He worked with Senate President Pro Tempore Glenn Coffee, who agreed to help get the compromise in a bill.

This is important step - but we have more to do. I still believe our public policy should be stronger and that our state should do a better job of supporting and protecting the rights of families with autistic children, in terms of available services, medical care, and fair treatment by insurance companies.

Thanks again for reading my “Senate Review.” If you have any questions on a
legislative matter, please do not hesitate to contact my Senate office at the Capitol by calling (405) 521-5555 or writing me with your concerns at: Senator Sean Burrage, 2300 North Lincoln Blvd. Rm. 529-B State Capitol Building, Oklahoma City, OK 73105.

I always enjoy hearing from my constituents and consider it an honor to be your voice in the Oklahoma State Senate. May God bless each of you.

Click here to link to the article.

Mo. Senate passes autism insurance mandate

Associated Press - May 6, 2010 1:14 PM ET

JEFFERSON CITY, Mo. (AP) - Senators have passed what they describe as a compromise bill to require insurance coverage of autism treatment for children.

The legislation would require group insurance policies regulated by the state to cover up to $45,000 annually for behavioral therapy for autistic children through age 18. The mandate would begin Jan. 1.

Senators passed the bill 27-6 Thursday. It now goes back to the House, which had passed a version with lower coverage caps earlier this year.

The annual coverage caps would apply only to "applied behavioral analysis," an intensive therapy that some parents say produces dramatic improvements in their autistic children.