A tactic used by insurance companies to deny expensive behavioral therapy to autistic children has been deemed illegal by a Los Angeles judge. In a preliminary ruling, Los Angeles County Superior Court Judge James C. Chalfant found that Kaiser Permanente's refusal to pay for a child's autism treatment because the provider was not licensed by the state runs counter to California's Mental Health Parity Act. That act requires insurers to cover care for mental and behavioral problems at the same levels they do for physical illnesses. "A refusal to pay for . . . services based on the fact that the provider is not licensed is inconsistent with the intent of parity," Chalfant wrote in his Oct. 20 ruling. It's the latest development in a long-running battle by parents nationwide to require insurers to pay for treatment of their autistic children. One of the most promising -- and expensive -- treatments is known as applied behavioral analysis. Therapists break down tasks such as feeding and dressing into tiny steps, then teach their autistic patients to master them through repeated drilling and rewards. The ruling came as part of a lawsuit filed by Consumer Watchdog, a Santa Monica advocacy organization, against the California Department of Managed Health Care to require the agency to side with consumers when insurers refuse to pay for the autism therapy. The ruling clears the way for a trial to determine whether the department, which is responsible for regulating health plans, is doing enough to require insurers to cover such treatment.
In a preliminary ruling, Los Angeles County Superior Court Judge James C. Chalfant found that Kaiser Permanente's refusal to pay for a child's autism treatment because the provider was not licensed by the state runs counter to California's Mental Health Parity Act. That act requires insurers to cover care for mental and behavioral problems at the same levels they do for physical illnesses.
"A refusal to pay for . . . services based on the fact that the provider is not licensed is inconsistent with the intent of parity," Chalfant wrote in his Oct. 20 ruling.
It's the latest development in a long-running battle by parents nationwide to require insurers to pay for treatment of their autistic children. One of the most promising -- and expensive -- treatments is known as applied behavioral analysis. Therapists break down tasks such as feeding and dressing into tiny steps, then teach their autistic patients to master them through repeated drilling and rewards.
The ruling came as part of a lawsuit filed by Consumer Watchdog, a Santa Monica advocacy organization, against the California Department of Managed Health Care to require the agency to side with consumers when insurers refuse to pay for the autism therapy. The ruling clears the way for a trial to determine whether the department, which is responsible for regulating health plans, is doing enough to require insurers to cover such treatment.
And Kaiser is one of the best HMOs. They are obviously as capable of hiring or retaining qualified therapist for autism in addition to all of the other specialties they have. But it won't be cheap, given the current incidence of autism. As the Dutch said while fighting the Spanish: "It is not necessary to have hope in order to persevere."
on some level these kids' inability is a reflection of the looneytoon cog-diss asked of them.
little human canaries, mirroring our cosmic cluelessness about what surrounds us... ~"When an inner situation is not made conscious, it appears outside as fate." Karl Jung~
