Who Covers the High Costs of Autism?

In the past decade the amount of money spent on treatment for Autism has jumped from $50 million annually to $320 million annual – in the state of California alone.  This is over 600% and rising!  Throughout the U.S. the amount is hovering at about $90 billion and is expected to double within the decade.  Research is on the rise – with NIH looking at testing non-traditional treatment to see what might work.

While autism is seemingly getting attention, there is a huge runaround occurring between parents of autistic children, insurance companies and the states.  This runaround is being played out throughout the country in the majority of states.  With autism having become more prevalent over the past ten to fifteen years, the demand for services has risen substantially.

Parents are doing what they can, but it is estimated that the cost to treat a child with autism for one year is often over $70,000.  Most families cannot afford this amount, so they rely on their insurance to offset these costs.  Unfortunately, many insurance companies and PPO’s will diagnose autism, but will not cover the cost or provide most of the treatment that they suggest when diagnosing the issue. 

Insurance companies say that this is because they can only provide services that are medically necessary, and they do not cover services that can be obtained elsewhere, such as through schools and other community programs.  Insurance companies also say that they do not cover procedures and services that are considered experimental, and that a lot of the proposed treatments for autism are still in the experimental stages.

As far as the states go, it has been charged that they are not doing their job either because they are handing care for individuals with autism over to the insurance companies.  As a result, while parents – especially those not covered by state benefits and other resources – continue to pay premiums and not receive services they need, the state and the insurance companies continue to go back and forth.

Enough parents are frustrated with the situation that some class action law suits have been filed in an effort to force the state and the insurance companies to take action and help families with autistic children.  While this issue plays out, children are not getting enough care and parents are not getting enough help.  Hopefully these law suits will help stop the debate and help families who need it.

Entry Filed under: Treatment Types

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