Jewish Journal

Health Insurance Wars

by Michelle K. Wolf

August 19, 2011 | 7:35 pm

People buy health insurance (or their employers purchase for them) for just one reason –to get help when they are sick. Why else should you (or your employer) pay monthly premiums? For people who are generally healthy or have common medical conditions, health insurance can work pretty well, taking care of, for example, ear infections in little ones, physical therapy for bad backs in middle-aged folks and even heart problems for grandparents.  But for parents raising a child or teen with developmental disabilities or other complex medical conditions, it feels all too often that you are on the frontlines of an epic battle.

According to Marty Omoto, Director of the California Disability Community Action Network, there’s a very important piece of pending legislation in Sacramento authored by Senate President Pro Tem Darrell Steinberg (Democrat - Sacramento, 6th State Senate District) that would require health managed care plans and health insurance plans to provide behavioral health treatment for persons with autism spectrum disorders as a covered benefit.

This bill, SB 770, would mandate coverage of behavioral health treatment, such as Applied Behavioral Analysis (ABA) and other intensive early intervention therapy, for thousands of people with autism spectrum disorders. The bill expands the list of qualified autism providers to include any licensed or nationally certified professional, or any provider of these services approved as a vendor by one of California’s 21 non-profit regional centers which contract with the Department of Developmental Services to provide or coordinate services and supports for individuals with developmental disabilities.

Sponsors of the bill include Autism Speaks, Alliance of California Autism Organizations, Special Needs Network, and The Help Group. 

Steinberg is hoping to see SB 770 passed before the Legislature adjourns for their year on September 9th but the bill is expected to face fierce opposition from managed health care plans, who in the past have said that behavioral health treatments for autism should be provided by school districts and the state-funded regional centers. Naturally, both the school districts and regional centers expect for private insurance to pick up the tab. In the middle of this high stakes game of “eeny, meeny, miny, moe” are the parents of children diagnosed with Autism Spectrum Disorders, just trying to get funding for their child.

I have collected my own share of gray hairs dealing with our various health insurance companies, and the situation was much worse when we opted for less expensive HMO coverage (we have since bit the bullet and moved over to the much more expensive PPO coverage). One particularly bizarre situation was when Danny was around 9 years around and developed ataxia, a condition that threw him off balance and stopped him from being able to walk independently. He had outgrown a toddler’s stroller and needed a very expensive bigger type-stroller and the government-funded California Children Services would pay for it completely but only if we got a denial letter from our private insurance company. I have a distinct memory of sitting in my car on roof of the LA Jewish Federation’s parking lot, crying into my cell, “Please, we desperately need you to deny us in writing”.

Although this bill doesn’t address that particular issue, it sends an important message that health insurance companies have to make it easier for families raising children with special needs and developmental disabilities to get the services they need to treat their medical conditions.

It’s clear that our side could use some bigger guns, like SB 770.





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