As the Director of Outreach for First Children Learning Services, a company that specializes in autism treatments, I am very familiar with navigating insurance companies in order to fund proven autism treatments. In 2010 the New Jersey Autism Insurance Act went into effect which mandated that many private insurance companies cover applied behavioral analysis which is the most proven treatment method for children with autism.
It was very exciting to know that these children would finally receive this much needed benefit. Over the past few months however, First Children Families have encountered extremely unfortunate and heartbreaking circumstances as the New Jersey Autism Insurance laws exempt self-funded and Medicaid from funding this medically necessary treatment modality.
Self-funded insurance plans are becoming extremely popular among larger employers. Nearly half of employers with 200-plus workers choose to have self-funded plans. This figure jumps to 88 percent for companies with at least 5,000 employees. In a self-funded plan the company finances its employees health care with its own assets, gaining a greater control over the benefits it offers.
ERISA (Employer Retirement Income Security Act) protects and exempts self-funded plans from some state insurance requirements including coverage for applied behavioral analysis. This exemption is absolutely devastating for the area’s autism community. Living in such a metropolitan area, a very large number of parents work for large companies that seem to choose self-funded plans. It appears that the children of New Jersey that are autistic are stuck in detrimental and unfair treatment policies.
This law will have a direct effect on the prognosis of these children, as well as a direct effect on the cost that New Jersey’s school districts will have to pay to help those children who are not eligible “catch up” when they become school aged. It is proven that the earlier intervention occurs, the better the prognosis is.
At this point, I have had to witness so many denials in coverage and be the one to break the news to the parents, that I feel obligated and inspired to do something about this. Just this morning I had a neighbor of a child that we are treating call to inquire about coverage for her own autistic son. I spoke with her and let her know that since her company self-funds her benefits her child would not be eligible. She broke down in tears and explained how she spoke with her neighbor about all of the progress her neighbor’s child is making with applied behavioral analysis services. She described feeling broken down and hopeless that her child will ever receive the care that he deserves. Both her and her husband work for larger companies and she cannot wrap her head around the fact that no matter how good their jobs are, they are unable to receive this medical treatment for their child.
What do you say to this parent? How many times will I have to hear the frustration and distress in a parent’s voice? The real question is, however, “why benefits for only some?” Our children all deserve equal rights, and equal opportunities. How long do we have to wait for this is occur?
Director of Outreach
First Children Learning Services