Blue Cross to cover autism

From Crain's Detroit Business:

Blue Cross Blue Shield of Michigan has reversed its policy and now will offer treatment coverage for children, mostly preschool age, diagnosed with autism.

The catch is that Blue Cross is offering the coverage only for children ages 2 to 5 whose families are insured under their companies' group policies that offer mental health coverage. Blue Cross also said it will market the coverage to self-insured employers.

While the autism coverage will not immediately affect an ongoing federal lawsuit against Blue Cross, Helen Stojic, the insurer's corporate affairs director, said autism coverage will improve the health and welfare of Michigan families and children with autism.

“We saw a need in the community and moved to find a way to address it,” said Thomas Simmer, Blue Cross' chief medical officer.

Last year, a class-action lawsuit was filed in federal court in Detroit against Blue Cross under the Federal Employee Retirement Insurance Savings Act, or ERISA, for denying autism treatment claims.

Troy-based Mantese & Rossman is seeking people who have been denied coverage for applied behavioral analysis treatment within the past six years.

Nearly 14,000 children in Michigan, or about 1 in 150, were diagnosed with autism in 2008, up from 7,259 in 2003, said the Michigan Public Schools Autism Prevalence Report.

“Even though we are offering the coverage now, we still consider the treatment to be experimental and investigational,” Stojic said.

David Meador, CFO of DTE Energy Co. in Detroit, who is one of two Detroit businessmen promoting proposed state legislation that would mandate that insurers, including Blue Cross, offer autism coverage, said the Blues' offer for autism treatment coverage is a good first step.

“Compared with the insurance reform we are talking about, this is a small step in the right direction,” said Meador, who has a 13-year-old daughter, Maribel, with Asperger Syndrome, a high-functioning autism disorder.

Still, pending approval by the Michigan Office of Financial and Insurance Regulation, Blue Cross would be the first insurer in Michigan to offer autism treatment programs, Stojic said.

A new study indicates that the average age of autism diagnosis is 5.7 years, according to the May issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Jim Todd, professor of psychology at Eastern Michigan University, said improved screening and greater sensitivity to autism by psychologists and physicians has lowered the average age of diagnosis.

“It is possible to diagnose autism symptoms when children are two to four years old. This is where autism symptoms start showing up,” Todd said. “Diagnosis depends on the extent of insurance coverage.”

Meador said Blue Cross's offer to cover only preschool children will miss a large portion of children with autism.

“It is very expensive. We spent $3,000 for an assessment,” he said. “The problem with what Blue Cross is offering is that it constrains on age, and the 60-visit limit is significantly less than the insurance reform we are talking about.”

Blue Cross will continue to cover services for children with autism under its mental health benefits, which include an initial examination and evaluation for speech therapy, Stojic said.

The price of the new benefit option will depend on the group, Stojic said. It will be limited to 60 sessions under the standard treatment program for autism, or Applied Behavioral Analysis.

“This is a reasonable new offering which does not unduly create a price impact on customer groups that would affect their ability to continue to provide health care coverage to their employees,” Simmer said.

State Rep. Kathy Angerer, D-Dundee, has introduced House Bill 4476, which would require Blue Cross to provide coverage for autism. Rep. Richard Ball, R-Bennington Township, has introduced HB 4183, which would require all insurers to provide coverage for autism.

Sen. Tupac Hunter, D-Detroit, also has introduced identical bills in the Senate: SB 359 and 360. Similar bills were introduced in 2007 and 2008 and were not voted on.

Over the past two years, 10 states have enacted legislation to require insurance companies to cover autism treatments. They are Arizona, Connecticut, Colorado, Florida, Illinois, Louisiana, Montana, Pennsylvania, South Carolina and Texas.

Stephen D'Arcy, global automotive leader for PricewaterhouseCoopers in Detroit, said he and Meador are meeting with a variety of business groups, including the Michigan Chamber of Commerce, to enlist support for the bills.

“The economics are clear, and it is the right thing to do,” D'Arcy said.

Insurance companies generally are opposed to mandated benefit requirements because it can drive up the cost of premiums.

But Meador said he has met with Michigan-based companies, such as CMS Energy Corp., Masco Corp., Meijer Inc. and DTE, that are considering offering autism coverage as a benefit.

Most states, including Michigan, do not require insurance companies to cover treatments and services for autism. Annual treatment costs can range from $30,000 to $50,000 per year.

“Business is naturally concerned that the legislation is not a blank check,” Meador said. “Just having behavioral therapy puts children in a position to learn at school, and this helps immensely down the road.”

Meador said the Michigan legislation needs to be modified to place caps on coverage, possibly a $35,000 annual maximum, and also exclude companies with less than 50 employees.

“Studies have shown providing autism coverage saves money in the long run,” said D'Arcy, who also is chairman of Detroit Medical Center. “The state and companies pay millions of dollars in autism care. This bill will reduce lifetime costs by 50 percent to 70 percent.”