01 Dec Autism Enters Into Benefits Equation

When Michael Kulstad’s son, Cameron, was diagnosed with autism at age 4, Kulstad knew he faced years of expensive medical treatment.

. . . Unfortunately, his employer, an international law firm, didn’t provide such comprehensive coverage. Kulstad struggled to coordinate care for his son and manage the red tape involved in getting just part of Cameron’s therapy covered.

. . . Unlike other chronic medical conditions diagnosed in childhood, autism is sometimes mislabeled as a learning disability and doesn’t qualify for coverage under some insurance plans. The National Institutes of Health defines autism as “a developmental disorder that appears in the first three years of life and affects the brain’s normal development of social and communication skills.”

. . . [Twenty-three] states have mandated autism coverage, with such initiatives currently making their way through 22 other state legislatures and the District of Columbia. But state mandates aren’t a panacea for parents of autistic children. The laws can’t require companies with self-funded insurance plans . . . to offer autism coverage. ERISA exempts such plans . . . from compliance with state insurance laws.

. . . Douglas Nemecek, the national medical director of behavioral health for Cigna Corp., the Philadelphia-based insurance company, also receives more inquiries from companies about autism benefits. Some employers “recognize the significant impact the autism spectrum disorder is having on the employees and their family,” he said. “On the other side, they are balancing that with concerns for the cost of these treatments, especially with the cost associated with the intensive Applied Behavior Analysis treatment,” which is individualized behavior-based therapy.