WARNING – NSFW RANT ALERT: I help pay for your heart attack. I help pay for your diabetes. I help pay for your car accidents. Heck, I even help pay for your Viagra(TM).
That is what insurance is about.
Shared risk. Shared benefits.
But, if your kid (or my kid) has autism (or many other special needs), things are different.
Insurance companies, regulators, and governments work, actively work to deny these kids services.
Or make them more expensive.
On December 20th, 2017, my wife and I received a letter from Kaiser*. They’ve “redefined” speech therapy, occupational therapy, and physical therapy for children with “autism or pervasive developmental disorders” as a “general benefit” instead of a mental health benefit.
Basically, the ONLY PEOPLE THIS AFFECTS ARE CHILDREN WITH AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS.
… and it is probably the autistic kids “fault” because we are a large enough group to cost insurers a meaningful amount of money, but not big enough or organized enough to lobby for full coverage.
You know, like old guys with limp dicks.
What does that mean?
More money more quickly for Kaiser (and the other insurance carriers), basically.
How does it work?
So, instead of paying a co-pay for each appointment ($30 in 2016 as a mental health service), we get to pay for the full service (close to $200 per session) until we hit our deductible (I think it was $1000 for our son in 2016)…. then, we get to pay co-pays until he hits his out of pocket maximum ($3000 for him, I think, you know how easy it is to decode health insurance).
Cash for Kaiser per week:
Current System / New System * Sample, your mileage (and mine) may vary a lot
$30 / $200
$30 / $200
$30 / $200
$30 / $200
$30 / $200 Hit deductible
$30 / $30
Until the year ends or you hit your out of pocket maximum.
(By the way, I never even THOUGHT about my out-of-pocket maximum until my son was diagnosed with autism, now it is part of our family budget every year)
Annoying for us, not devastating.
If they had sent us this letter a couple of months ago, we would have changed some of our health savings options and such… you know, saved some money.
… we’re trying to fix it today after the official deadline.
Not just “No”, but “Hell No”
Let’s talk about the first letter we got from Kaiser after my son’s autism diagnosis.
Less than one week after we got his diagnosis. Before we were authorized ANY services (THAT took a month or so), we received a “pre-emptive denial of services” for Applied Behavioral Analysis (ABA) therapy.
Until my son got his autism diagnosis I didn’t know what Applied Behavioral Analysis was.
In short, it is an intensive, one-on-one therapy process where an individual therapist works with an autistic child (usually) to “train” them with speech skills, social skills, and other social and coping skills. One by one.
ABA is the single, proven therapy for kids with autism since the 1970s.
40+ years now.
My son gets 15 hours a week (3 hours a day, 5 days a week) in addition to his 4 hours a day of special ed pre-school and 1 hour of speech therapy.
Yep, my 4 year-old has a full time job.
… back to ABA…
For example, in order to teach my son to ask for things (instead of grabbing your arm and pulling you somewhere), they taught him to say:
“I want (a cookie), please”.
Or whatever else he wants.
For (some) kids with autism, this is how they learn to communicate. Script by script, phrase by phrase, until, hopefully, they build up useful communication skills so that they can interact with people who don’t know they are autistic in a functional manner.
This does lead to some humorous quirks. My son still has trouble with “Yes” and “No” (we started getting some success around his fourth birthday this October), It almost hurts him to say the phrases as he struggles to get the ideas out. His current variation on “No” is:
“I want No Thank you, Please”.
You have to laugh or you’ll cry.
So, anyway, buried in our 200 page health insurance long form coverage package (you read that every year, right?) in 2016 was a section on Exclusions.
Go look your’s up, I’ll wait.
Most of the exclusions are pretty logical. Basically, they protect the insurer from abuse of their systems and services.
Standard contract stuff.
In 2016, in the US Government insurance package was one single, explicit insurance exclusion.
“No coverage for Applied Behavioral Analysis”.
If you don’t have a kid with autism, this means nothing.
It might as well mean “No coverage for Martians”.
But, if your kid has autism, it basically says…
“Yep, we cover a whole lot of things for a whole lot of people, but if you have autism..”
because this service applies to pretty much only kids with autism or other similar disorders.
…. and the Federal government had “recommended” that insurance companies cover it for a number of years.
… but they didn’t REQUIRE it.
Guess what the insurance companies decided to do?
Yep, EXCLUSION for us.
No help with the one proven autism therapy with a 40 year track record.
… but a happy ending (or beginning)
Fortunately, for us, US Government policy changed in January 2017 to require coverage for ABA.
… we contacted our doctor and got my son’s ABA reauthorized the first week of January 2017.
…and it took until June for us to get services started (don’t ask… really!).
So, we’ve finally got a fairly reasonable set of services in place, at least the best we can do so far.
The “Gift” this month from Kaiser (and probably other insurers) does remind all of us to keep on our toes.
If you are disgusted with this, come join me at SNKIDS.ORG. If you have any questions or comments, email me at: email@example.com.
* Note: I will say that excluding our autism related services for our son, we have been very happy with Kaiser. I don’t think the problems we are experiencing are unique to Kaiser, but I’m not going to give them a Christmas card this year either. They have a choice and they’ve chosen to screw autistic kids and their families and not raise your (and my) insurance rates to cover their services.