Blue Shield of California Agrees To Cover Autism

Millions of people are affected by neural developmental disorders that all fall within the umbrella-label of autism. The effects can be devastating or mild. Many people with autism can still function independently, but some require early treatment and rigid intensive therapies. Due to the regular and expensive treatment that autism may require, many CA health insurance companies have declined to cover it.

For the past two decades, California health insurance has tried to avoid covering the treatment for autism-related problems. According to some insurance companies, the treatment for autism should be considered educational rather than medical. However, after a hearing conducted at the Senate Capitol last July 13, Blue Shield of California has conceded to cover behavioral therapy for autism-related problems.

California Health Insurance Faces Legislative Intervention Over Covering Autism Treatment

Darrell Steinberg, California Senate President Pro Tem, authored two of the senate bills addressing autism, autism treatment and health insurance in California. One of the bills, namely Senate Bill 166, required that CA health insurance providers cover early-intervention therapies for children with autism. According to Steinberg, the bill would make such therapy consistent in the insurance industry.

Senator Steinberg argued that prompt identification of autism and early treatment from the beginning has been found to be more effective. That alone could have a huge impact on the long-term medical treatment and supervision requirements for several decades.

When Will Blue Shield Of California Start Covering Autism Treatment For Children?

On July 11, 2011, Blue Shield of California signed an agreement that took effect immediately to cover a type of autism therapy that it previously refused to cover. Only Blue Shield members whose insurance policies are overseen by the Department of Managed Health Care will benefit from this, though.

Under the terms of the agreement, CA Blue Shield said it will not deny coverage for autism therapies, although it will consider the medical necessity of such treatments. Applied Behavioral Analysis (ABA) or behavioral intervention therapy is the standard health care therapy from a professional therapist for children with autism.

ABA focuses on teaching children how to relate to others on a personal basis from an early age. It is a very expensive form of therapy that routinely costs around $100,000 annually. California health insurance companies know about the cost of this treatment and that is why they strongly oppose the mandate to cover autism treatment.

Will California Health Insurance Premiums Rise When Autism Treatment Is Covered?

Industry representatives say that mandating ABA will only lead to higher premiums for everyone. Steinberg contested that although the mandate will cost policy holders some additional out-of-pocket costs, it stands to eliminate a lot of future costs that would be faced without early intervention.

Twenty five states have passed laws mandating autism treatment coverage for children. Anthem Blue Cross has agreed to cover such treatments and California Blue Shield has agreed to avoid interruptions in care, and to expand access to health care providers. CA Blue Shield has only agreed to reimburse some policy holders for ABA treatments, though.