The Oregon Insurance Division announced on Friday it will begin drafting a bulletin to urge health insurers operating within the state to cover autism therapy.
The news will come as a positive development for families who have been lobbying insurance companies to expand their coverage to those with autistic children. The issue has dragged on for some time and the families have grown aggravated with the state's slow response to the issue of applied behavior analysis (ABA) treatment coverage.
ABA therapy, or behavior modification, can help children with autism by teaching them "social significant behaviors" such as reading, academics, social skills, communication and adaptive living skills.
Insurance Commissioner Laura Cali told OregonLive that the new law regarding expanded coverage for ABA treatment was influenced by a recent court decision for a family who sued Providence Health Plan after it declined to cover the ABA treatment of their children. As a result of the court case, Providence reversed its decision and started offering coverage. However, BlueCross BlueShield, Healthnet and the Public Employee Benefit Board of Oregon State continue to deny coverage. Local providers of ABA therapy insurance include Kaiser Permanente, PacificSource and Lifewise.
"For far too long children with developmental disabilities have been denied essential healthcare in this state," Brenna Legaard, mother of one of the plaintiffs and an attorney told OregonLive. "We are gratified that Commissioner Cali is taking steps to ensure that other families do not have to fight their health insurers for their children's futures the way we had to fight for our son."
As the country braces itself for changes regarding health care and insurance, one of the biggest issues that is yet to settle is ABA therapy. Expanding insurance coverage to such services is often rejected by health insurers because treatment and therapy sessions can be costly. According to the Autism Society, Oregon is one of the states with the highest rate of autism in the United States. If enacted, the change will benefit the families of those with autism, but may cause a strain on the insurance providers.
