Check out Wayne Rohde's interview with Fox 25's Britton Follett to discuss the details of Blue Cross Blue Shield of Oklahoma's announcement to cover autism services.
Click here to view the video.
Thursday, January 1, 2009
Details of BCBS Plan
Some of the details of Blue Cross Blue Shield of Oklahoma's plan were released via TV interviews on Tuesday, Dec 30, 2008. In the interviews with Fox 25's Britten Follett and OETA's Jason Doyle, Dr. Joe Nicholson stated that OT, PT, and Speech will be covered along with diagnosis of autism. There will be an annual cap of $ 25,000.00 for those services.
However, there will be no coverage for ABA or behavioral therapy due to BCBS's long standing and incorrect belief that ABA is experimental and does not have clinical research to prove it's effectiveness.
This type of statement has been a go to for the insurance company to deny children with autism the medical necessary and clinically proven therapies. BCBS did not take into account what the US Dept of Education, US Dept of Defense, the Surgeon General, American Academy of Pediatricians, and many other national and federal organizations and agencies have adopted as the most effective behavioral therapy, ABA or Applied Behavorial Analysis.
In what was thought to be an exciting development and breakthrough for members of BCBS of Oklahoma, it quickly fizzled out. However, we see this is a first step, perhaps small, but at least a first step towards providing the medically necessary and clinically proven treatments and therapies for our children and adults with autism in Oklahoma.
Wayne Rohde
However, there will be no coverage for ABA or behavioral therapy due to BCBS's long standing and incorrect belief that ABA is experimental and does not have clinical research to prove it's effectiveness.
This type of statement has been a go to for the insurance company to deny children with autism the medical necessary and clinically proven therapies. BCBS did not take into account what the US Dept of Education, US Dept of Defense, the Surgeon General, American Academy of Pediatricians, and many other national and federal organizations and agencies have adopted as the most effective behavioral therapy, ABA or Applied Behavorial Analysis.
In what was thought to be an exciting development and breakthrough for members of BCBS of Oklahoma, it quickly fizzled out. However, we see this is a first step, perhaps small, but at least a first step towards providing the medically necessary and clinically proven treatments and therapies for our children and adults with autism in Oklahoma.
Wayne Rohde
Monday, December 29, 2008
Blue Cross Blue Shield Adds Autism Benefits
Posted: Dec 29, 2008 09:57 PM
News9.com
OKLAHOMA CITY -- Blue Cross and Blue Shield of Oklahoma said it's adding benefits for children with autism. Many in the state hope this is a step in the direction to make all health care providers add autism benefits.
The company said benefits would cover evaluations and certain types of therapy without raising premiums too much. It will be available in 2010.
Advocates said Monday's announcement highlights the need to pass a law forcing all insurance companies to cover autism benefits.
"Blue Cross Blue Shield, with its customer base, will only reach a very small portion compared to what Nick's Law would do. But it does give us some validity that Nick's Law is necessary, we just wish we could do this to affect all of Oklahoma," Wayne Rohde with the Oklahoma Autism Coalition said.
Lawmakers will discuss the bill known as Nick's Law in February. It's named after Wayne Rohde's son who has autism.
Nick’s Law proponent skeptical of insurer’s new autism coverage
by Janice Francis-Smith
The Journal Record
December 30, 2008
OKLAHOMA CITY – After years of trying to force health insurance companies to cover costs related to autism, state Sen. Jay Paul Gumm responded with skepticism to the news that Blue Cross and Blue Shield of Oklahoma has decided to provide autism benefits.
“While I commend their effort, this appears to be an attempt to put the pin back in the grenade and forestall consideration of Nick’s Law in 2009,” said Gumm, D-Durant. Gumm was first in line to file a bill for the 2009 legislative session to require health insurance companies doing business in Oklahoma to provide autism benefits.
Senate Bill 1 is also known as Nick’s Law, named for the son of Edmond resident and head of the Oklahoma Autism Coalition Wayne Rohde.
State Sen. Patrick Anderson, R-Enid, and state Sen. Mary Easley, D-Tulsa, had also filed similar bills for consideration in 2009. Lawmakers anticipated a repeat of last year’s grass-roots effort, in which dozens of parents walked the halls of the state Capitol brandishing pictures of their autistic children, lobbying lawmakers to give Nick’s Law a chance.
In 2008, the battle came to a head in the House Economic Development and Financial Services Committee, which the chairman, state Rep. Ron Peterson, R-Broken Arrow, refused to hear the measure. Peterson, an insurance agent, maintained his position that insurance mandates drive up the cost of premiums.
Peterson withstood intense pressure throughout the 2008 session from the parents of autistic children who crowded the committee room and waited outside his office for a chance to speak to him. Though eligible to serve two more years in the Legislature, Peterson declined to run for re-election in November in favor of returning to the private sector.
In the end, the private market prevailed, said Oklahoma House Speaker Chris Benge, R-Tulsa, who had backed Peterson’s decision not to hear Nick’s Law in committee.
Today’s Blue Cross Blue Shield announcement is proof that when given the opportunity, the market works to encourage private companies like BCBS to provide services increasingly in demand within a community,” said Benge. “This debate has never been about a lack of desire to help families with autistic children whom we know are struggling to take care of their kids. We will be seeking ways to help these families without growing the uninsured population in this state or making it even harder for Oklahoma families already struggling to pay for health insurance now.”
Bev Binkowski, director of public affairs for Blue Cross and Blue Shield of Oklahoma, commended the Oklahoma Legislature for allowing the market to work.
“Rather than having a ‘one-size-fits-all’ mandate for all companies, we have been able to develop a benefit to meet the needs of our members,” said Binkowski. The company will provide “a clinically reasonable benefit” that will not dramatically increase premiums, she said.
Rohde said his group had already proven with actuarial studies that the benefits they requested would not significantly raise premiums. House Republican leaders had estimated the cost of the requested benefit would increase state employee health insurance costs by $6 million a year, but the autism advocacy groups had a study that showed the average premium would increase by $1.66 a month.
Rohde said he eagerly awaited details regarding the benefits Blue Cross and Blue Shield of Oklahoma would provide for autism treatment. Payment for behavioral therapies that have proven effective are critical aspect of the benefit parents have been clamoring for, he said. Rohde’s family pays about $5,000 per month on such treatments for their son Nick.
Gumm also questioned what benefits will be included in Blue Cross and Blue Shield’s new plan.
“While a step in the right direction, today’s announcement is only a small piece of the puzzle,” said Gumm. “We do not know caps on the benefit, we do not know precisely what therapies are covered.” The plan would not take effect until 2010, he added.
Neither Gumm nor Rohde took the news as evidence of the free market working.
“If it weren’t for the efforts of the parents (of autistic children in Oklahoma), Blue Cross and Blue Shield wouldn’t be making this announcement,” said Rohde. “This is a response to political pressure, not a response to market forces. Market forces are pushing the other way,” said Rohde, causing many insurance companies to cut back on benefits, not to add additional coverage.
The Journal Record
December 30, 2008
OKLAHOMA CITY – After years of trying to force health insurance companies to cover costs related to autism, state Sen. Jay Paul Gumm responded with skepticism to the news that Blue Cross and Blue Shield of Oklahoma has decided to provide autism benefits.
“While I commend their effort, this appears to be an attempt to put the pin back in the grenade and forestall consideration of Nick’s Law in 2009,” said Gumm, D-Durant. Gumm was first in line to file a bill for the 2009 legislative session to require health insurance companies doing business in Oklahoma to provide autism benefits.
Senate Bill 1 is also known as Nick’s Law, named for the son of Edmond resident and head of the Oklahoma Autism Coalition Wayne Rohde.
State Sen. Patrick Anderson, R-Enid, and state Sen. Mary Easley, D-Tulsa, had also filed similar bills for consideration in 2009. Lawmakers anticipated a repeat of last year’s grass-roots effort, in which dozens of parents walked the halls of the state Capitol brandishing pictures of their autistic children, lobbying lawmakers to give Nick’s Law a chance.
In 2008, the battle came to a head in the House Economic Development and Financial Services Committee, which the chairman, state Rep. Ron Peterson, R-Broken Arrow, refused to hear the measure. Peterson, an insurance agent, maintained his position that insurance mandates drive up the cost of premiums.
Peterson withstood intense pressure throughout the 2008 session from the parents of autistic children who crowded the committee room and waited outside his office for a chance to speak to him. Though eligible to serve two more years in the Legislature, Peterson declined to run for re-election in November in favor of returning to the private sector.
In the end, the private market prevailed, said Oklahoma House Speaker Chris Benge, R-Tulsa, who had backed Peterson’s decision not to hear Nick’s Law in committee.
Today’s Blue Cross Blue Shield announcement is proof that when given the opportunity, the market works to encourage private companies like BCBS to provide services increasingly in demand within a community,” said Benge. “This debate has never been about a lack of desire to help families with autistic children whom we know are struggling to take care of their kids. We will be seeking ways to help these families without growing the uninsured population in this state or making it even harder for Oklahoma families already struggling to pay for health insurance now.”
Bev Binkowski, director of public affairs for Blue Cross and Blue Shield of Oklahoma, commended the Oklahoma Legislature for allowing the market to work.
“Rather than having a ‘one-size-fits-all’ mandate for all companies, we have been able to develop a benefit to meet the needs of our members,” said Binkowski. The company will provide “a clinically reasonable benefit” that will not dramatically increase premiums, she said.
Rohde said his group had already proven with actuarial studies that the benefits they requested would not significantly raise premiums. House Republican leaders had estimated the cost of the requested benefit would increase state employee health insurance costs by $6 million a year, but the autism advocacy groups had a study that showed the average premium would increase by $1.66 a month.
Rohde said he eagerly awaited details regarding the benefits Blue Cross and Blue Shield of Oklahoma would provide for autism treatment. Payment for behavioral therapies that have proven effective are critical aspect of the benefit parents have been clamoring for, he said. Rohde’s family pays about $5,000 per month on such treatments for their son Nick.
Gumm also questioned what benefits will be included in Blue Cross and Blue Shield’s new plan.
“While a step in the right direction, today’s announcement is only a small piece of the puzzle,” said Gumm. “We do not know caps on the benefit, we do not know precisely what therapies are covered.” The plan would not take effect until 2010, he added.
Neither Gumm nor Rohde took the news as evidence of the free market working.
“If it weren’t for the efforts of the parents (of autistic children in Oklahoma), Blue Cross and Blue Shield wouldn’t be making this announcement,” said Rohde. “This is a response to political pressure, not a response to market forces. Market forces are pushing the other way,” said Rohde, causing many insurance companies to cut back on benefits, not to add additional coverage.
Statement from Sen. Jay Paul Gumm on Blue Cross and Blue Shield Announcement
Oklahoma State Senate
Communications Division
State Capitol
Oklahoma City, Oklahoma 73105
For Immediate Release:
Statement from Sen. Jay Paul Gumm on Blue Cross and Blue Shield Announcement
“The announcement today by Blue Cross and Blue Shield is yet another clear and convincing piece of evidence that Nick’s Law should become Oklahoma’s law.
Blue Cross and Blue Shield says they have developed a benefit that ‘doesn’t unduly create a price impact’. That statement corresponds with the actuarial study we provided that shows we can help autistic children for mere pennies a day.
While a step in the right direction today’s announcement is only a small piece of the puzzle. We do not know caps on the benefit; we do not know precisely what therapies are covered; we do know thousands of Oklahoma families will remain uncovered; we do know it will be more than a year before this benefit becomes a reality. While I commend their effort this appears to be an attempt to put the pin back in the grenade and forestall consideration of Nick’s law in 2009.
All Oklahoma families deserve autism coverage and they are waiting for their government to stand up for them. We in Oklahoma cherish our children and this fight for them does not end with this attempt to relieve political and market pressures.”
OK House Speaker comments on BCBS press release
CONTACT:
Jennifer Monies, Press Secretary
Oklahoma House of Representatives
Office of House Speaker Chris Benge
Office: 405-962-7679
Cell: 405-550-8144
Email: jenniferm@okhouse.gov
OKLAHOMA CITY (Dec. 29, 2008) – House Speaker Chris Benge issued the following statement in response to the announcement made today that Blue Cross Blue Shield will offer additional autism coverage to insured groups in Oklahoma effective at the start of their next policy year:
“Today’s Blue Cross Blue Shield announcement is proof that when given the opportunity, the market works to encourage private companies like BCBS to provide services increasingly in demand within a community,” said House Speaker Chris Benge, R-Tulsa. “This debate has never been about a lack of desire to help families with autistic children whom we know are struggling to take care of their kids. We will be seeking ways to help these families without growing the uninsured population in this state or making it even harder for Oklahoma families already struggling to pay for health insurance now.”
Blue Cross and Blue Shield of Oklahoma Announces Autism Benefits
Blue Cross and Blue Shield of Oklahoma Announces Autism Benefits
TULSA, Okla., Dec. 29 /PRNewswire-USNewswire/ -- Blue Cross and Blue Shield of Oklahoma announced today the addition of an autism benefit to insured groups effective their next policy year. This change will not in any way affect the current medical coverage that has always been available to children with autism. Blue Cross and Blue Shield of Oklahoma is responding to market interests in the benefits and coverage of certain autism-related medically necessary services.
"We want to commend the Oklahoma Legislature for allowing the market to work," said Bev Binkowski, director, public affairs. "Rather than having a 'one-size-fits-all' mandate for all companies, we have been able to develop a benefit to meet the needs of our members."
Blue Cross and Blue Shield of Oklahoma will provide "a clinically reasonable benefit that doesn't unduly create a price impact on small employer groups and affect their ability to provide health care coverage to their employees," said Dr. Joe Nicholson, Blue Cross and Blue Shield of Oklahoma's chief medical officer and vice president of health care management. Benefit enhancements are expected to include evaluation and management procedures, speech, physical and occupational therapies. The health plan is targeting a January 2010 implementation date for this new benefit.
"Blue Cross and Blue Shield of Oklahoma has been able to develop a benefit that won't dramatically increase premiums," Binkowski said. "This decreases the likelihood that the increased benefit will result in employers dropping coverage and adding to the state's uninsured population."
"This action will allow us to provide a benefit for proven therapeutic services while research continues to identify effective treatments or medical solutions for children with autism," Nicholson said.
Blue Cross and Blue Shield of Oklahoma is a member of the Affordable Access to Health Care coalition. For more information, visit www.affordableaccesstohealthcare.org.
SOURCE Blue Cross and Blue Shield of Oklahoma
TULSA, Okla., Dec. 29 /PRNewswire-USNewswire/ -- Blue Cross and Blue Shield of Oklahoma announced today the addition of an autism benefit to insured groups effective their next policy year. This change will not in any way affect the current medical coverage that has always been available to children with autism. Blue Cross and Blue Shield of Oklahoma is responding to market interests in the benefits and coverage of certain autism-related medically necessary services.
"We want to commend the Oklahoma Legislature for allowing the market to work," said Bev Binkowski, director, public affairs. "Rather than having a 'one-size-fits-all' mandate for all companies, we have been able to develop a benefit to meet the needs of our members."
Blue Cross and Blue Shield of Oklahoma will provide "a clinically reasonable benefit that doesn't unduly create a price impact on small employer groups and affect their ability to provide health care coverage to their employees," said Dr. Joe Nicholson, Blue Cross and Blue Shield of Oklahoma's chief medical officer and vice president of health care management. Benefit enhancements are expected to include evaluation and management procedures, speech, physical and occupational therapies. The health plan is targeting a January 2010 implementation date for this new benefit.
"Blue Cross and Blue Shield of Oklahoma has been able to develop a benefit that won't dramatically increase premiums," Binkowski said. "This decreases the likelihood that the increased benefit will result in employers dropping coverage and adding to the state's uninsured population."
"This action will allow us to provide a benefit for proven therapeutic services while research continues to identify effective treatments or medical solutions for children with autism," Nicholson said.
Blue Cross and Blue Shield of Oklahoma is a member of the Affordable Access to Health Care coalition. For more information, visit www.affordableaccesstohealthcare.org.
SOURCE Blue Cross and Blue Shield of Oklahoma
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