Change in Autism Insurance Coverage “Making a Difference” in Families' Lives

A historic shift in California’s insurance law will require private carriers to cover behavior interventions for autism

A historic shift in California’s insurance law will require private carriers to cover behavior interventions for autism – a therapy that parents Alan and Stacy Vo is working miracles with their son Sean.

At age 3 ½, they noticed something wasn’t clicking with their son.

“He couldn’t talk; he couldn’t look at you in the eyes. If he tried to give you something, he would go like this,” she said, holding her hand out and turning her head away.

Stacy and Alan turned to speech and behavioral therapy first, spending thousands of dollars on the treatments. When they submitted those bills to their insurance carrier, they were denied.

“When I got the rejection letter from the insurance, I thought, ‘This is wrong,’” Stacy said. “And I called them back and they denied it based on the reason that it’s not medically necessary.”

The Vo’s wouldn’t accept that reasoning: they collected research, sent letters, made phone calls.

“We went through hell to fight for it,” she said.

Eventually, the state required their insurance company to take over payments for Sean's therapy.
Autism affects 1 in 88 children nationwide; and in California, at least 72,000 people have the condition.

Starting this month, most plans will have to cover the intervention, called applied behavioral analysis and widely believed to be one of the most effective treatments for the autism and other developmental disorders.

The therapy involves working intensely with a child or adult to break down even the most simple of social and vocational tasks into tiny steps that can be learned by most people.

“Right now, they’re doing a miracle on him. They’re working on social skills; they’re teaching him how to play properly,” Stacy said.

Weeks of intensive therapy – two hours a day, four days a week – and Sean is proving skeptics wrong.

“It makes a difference in kids’ lives,” Stacy said.

Stacy said it took doctors more than nine months to officially diagnose her son with autism.

If kids receive treatment for autism earlier in life – while their brains are still developing – they have a better chance to see results, said NBC4 health expert Dr. Bruce Hensel.

“This makes a major difference,” Hensel said.

But even though the goal of California’s historic move to require insurance companies to make the intervention available to most Californians through their insurance, many plans will not offer it.

That’s because most of the largest employers are exempt from state requirements under a 1970s-era law that was actually meant to protect privately funded pension plans.

Most large employers fall into this category, which means that covering behavioral therapy for autism will be voluntary for them.

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