LEESBURG, Va., June 21, 2009
Insurance Companies Refuse Autism Coverage
Total Cost For A Child Can Reach $5 Million, But Few States Mandate Coverage; Is Change On The Horizon?
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Play CBS Video Video Treating Autism One in every 150 children in America has autism, and the number of reported cases are growing. The total cost of caring for an autistic child can be expensive. Thalia Assuras reports.
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Korlan Oldham of Leesburg, Va. receives one-on-on one behavioral therapy to treat his autism. The medical and therapy costs associated with autism can be astronomical, but insurance companies rarely cover them and only seven states have laws mandating that they do. (CBS)
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Interactive Breaking The Silence Find out more about autism, and where to get help for someone who may have this neurological disorder.
The total cost of caring for an autistic child can reach a staggering $5 million.
Parents are increasingly demanding that insurance companies cover the newest treatment. CBS News correspondent Thalia Assuras visited one such family in Virginia.
At 7 years old, Tristan Oldham is the big brother in this rambunctious trio. A couple of years younger is Gareth - bubbly and playful until he was two.
That's when "he slowly stopped playing. He would sit in a corner and chew on his shirt and play with the shadows," said mother Cassandra Oldham.
Gareth was diagnosed with autism. Nine months later, as Cassandra and Bill Oldham struggled to cope with Gareth's condition, they suffered another blow. Their third child, Korlan, is also autistic.
"I can't even describe it in words really. Just pain. Pain. Gut-wrenching more pain," Cassandra Oldham said.
The emotional anguish was multiplied by financial stress.
Intensive, one-on-one behavioral and speech therapy called "applied behavior analysis therapy" or ABA helps the boys. But it costs up to $7,000 a month per child for the recommended 40 hours per week. The Oldhams struggled to pay even half the amount.
"Which child do you choose? We don't have enough money to pay for therapy for both of them," Cassandra Oldham said.
The Oldhams have insurance, but not for autism therapy because Virginia isn't one of the seven states that mandate coverage. Businesses say adding autism to the list is too expensive.
"Prosthetics, mental health, stress, hypertension: all of these things lead to a cumulative effect that runs the risk of putting the insurance out of reach for the average business person and the average employee working for that person," said Hugh Keogh of the Virginia Chamber of Commerce.
Cassandra Oldham and state Delegate Bob Marshall don't buy it. They are pushing legislation that would force insurers to cover ABA, and say the costs of a policy would be minimal - somewhere between $2 and $4 a month.
"There are real children whose lives are going to be destroyed because we are acting indifferent to them. That's not a moral response," Marshall said.
But in tough economic times, states like Virginia are trying to figure out how to do the most good with fewer resources.
"Ii have a lot of fear when I think about the future and where my kids will be at," Cassandra Oldham said.
They've thought about moving to a state where their boys can get all the help they need.
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Michelle Obama tells how her role as the First Lady has changed her perspective.
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See all 24 CommentsFirst of all, my Autistic son was not given the "autism" vaccine. We held off on vaccinating him and his siblings specifically because of the Autism controversy. However, he is severely Autistic.
Normally parenting skills do not work with these children, and ABA needs to be administered by a trained professional. Studies have shown that it is only effective when worked on at least 30 hours a week. This is a strain on the entire family, as these people are in your home all the time, and it is not because we are lazy parents. If we could meet this need ourselves, we would.
To those who think the case in this article is rare....sadly, it is not. Our private insurance does not cover services, nor does it for the more than dozen parents I know with Autistic children on HMO plans. Even the services we should receive through the State Health dept. have to be fought for, and even then children go untreated.
Being the parent of an Autistic child is extremely heartbreaking, and the comments by people here do not help. Perhaps you should spend some time around an Autistic child before make sweeping judgments about them and their families, who try so hard to care for them and give them a normal life.
But, what do I know, I was born with Autism?
"Cherry picking" by insurance companies is not within the scope of compassionate people, what is the expression: "There, but for the grace of God am I"
An insuranced company's denial of any sickness or condition should not be permitted!
Herein is an argument for a governmental operated insurance program. It is time for we citizens go get behind our President's leadership in this most important area of quality of life.
"Cherry picking" by insurance companies is not within the scope of compassionate people, what is the expression: "There, but for the grace of God am I"
An insuranced company's denial of any sickness or condition should not be permitted!
Herein is an argument for a governmental operated insurance program. It is time for we citizens go get behind our President's leadership in this most important area of quality of life.
When are WE going to grow up and start focusing on prevention. WE know that we are pumping toxins into our environments daily. Many of the over 30,000 in new pharmaceuticals that are used in nearly all household products have never been tested for their combined impact, for their impact on developing fetuses, even though some researchers have found tiny trace amounts to be endocrine disruptors that impact both potential intelligence and reproductive ability.
Schmucks that WE are, we're easy prey for industries that threaten cutting jobs IF they are forced to make quality products that do not handicap our children for life. How about DEMANDING a safe and healthy environment for all of us. Are we really such industrial dodos that we can only make money by ignoring the impact of industry on the environment and our health? I'd like to believe that America has the creativity to come up with new products that make a profit for businesses AND avoid contaminating the air we breathe, the water we drink, and the food we eat.
"Their third child, Korlan, is also autistic."
<Amazingly ignorant. STOP HAVING CHILDREN YOU STUPID, STUPID people!>
OK, #1, read the article. The third baby was born nine months after the second child was diagnosed. The first child is not autistic. My guess is that they were pregnant before they really knew the issue with the second.
#2, although they are looking at a variety of related genes, it's not like having one kid with autism is automatically going to make the rest of their kids autistic. Afterall, their first kid was normal.
And insurance companies cover what they feel like covering. When 25 year old insurance "sales people" with only three years at the company are making six figures and being treated to company paid vacations in Hawaii (this is someone I know, I'm not making it up) I have to question their ability to even run health insurance as a business. It seems like their way to run their own country club.
That said - I think this article is kinda disingenuous - 40 hours a week of therapy? What are the parents doing - nothing? Most types of therapy I've seen involve the parents, you have some time with the therapist with the kid, and they give the parents homework to continue the theme. Every other day should be plenty with that. I think they're trying to exaggerate the difficulties here.
I say this as someone with a child receiving therapy - for a far more minor problem (speech delay) - and I get 1 hour once a week - the rest is me and her father at home. This is a far worse problem - but I just can't imagine 40 hours a week being useful even - no way is all of this something the parent completely cannot do even for a day or so on their own.
Even more Democrats support a public health plan.
The fact that this will probably not happen just shows us who really runs America. It's not the people.
Amazingly ignorant. STOP HAVING CHILDREN YOU STUPID, STUPID people!
Universal health care, like every other civilized country has had for decades. Covers all those here legally, for appropriate medical care, selected by scientific and medical standards that determine what treatments are the most cost effective solutions to diseases, what is a necessity, and what is a luxury (plastic surgery for a pretty nose is a luxury - plastic surgery for a deformed nose causing breathing difficulties is a necessity).
There is no enormous expense - in every country that has enacted this, their costs are drastically LESS than ours - even while our health care patchwork covers only a fraction of our citizens and theirs covers everyone. Unless Americans are somehow considered to be that much stupider than EVERY OTHER CIVILIZED NATION - I think we can manage to do the same thing. The costs will be lower - we'll save money that currently goes to pay insurance executives to find more new ways to deny coverage.
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See all 24 Comments