Wednesday, May 18. 2011

Insurance Coverage for ABA Services

In recent weeks, we've had mixed experiences working with insurance companies and obtaining coverage of ABA services. The hard work of parents and advocates has really paid off in some states, such as Minnesota, Indiana, Pennsylvania, and New Jersey. We've even seen great progress with military insurance coverage thanks to the work of Jerry Shook and others with the Behavior Analysis Certification Board. But California is a different state of affairs.

The small subgroup of families that even have ABA services included in their health insurance plans are now finding out that the only ABA services authorized require 100% implementation by licensed clinicians. Now as a licensed clinical psychologist myself, I know that it is unrealistic for me to be present for every hour of a child's intervention. Not only is it cost-prohibitive for a licensed provider to be present for every hour of ABA intervention, it isn't evidence-based practice! The data on intensive ABA programs has historically relied on the undergraduate student implementers of the intervention, not licensed professionals.

Now, if I were an alarmist, I would say the insurance companies are imposing this requirement solely to reduce their costs. However the cost benefit analyses of early intensive behavioral intervention clearly demonstrate that intervening early and intensively costs significantly less than long-term care. Not to mention that early intensive behavioral intervention results in children achieving significant skills that allow them to more fully participate and integrate in their families, schools, and communities.

Additionally, some of the actuarial data presented on actual costs that would be incurred by consumers demonstrate that costs may only increase by 1-3% if early intensive behavioral intervention was funded for all children with autism.

It took a band of parents and providers to change awareness regarding autism services in the 80's and 90's. Look at how far we've come with IDEA and the Lanterman Act here in California ensuring that children have a right to an appropriate education leading to inclusion with typical peers to the greatest extent feasible.

A wise man once told me that nothing in life worth having comes easy. True worth usually comes at the expense of great effort. I have to agree when I look at the plight of many of the families we serve contemplating insurance funding here in California. This is the new battle for the current generation of parents and providers. The families that have succeeded in obtaining funding will tell you it was worth every minute of their time in order to obtain effective services for their child. We would like to encourage you through the process and to support one another in your efforts. Please share if you have advice for others about what worked, what didn't, or if you yourself would like advice.

- Scott Cross, Ph.D., BCBA-D
Clinical Director, West Coast

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