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Insurance Coverage for Autism

Insurance Coverage for Autism. Ruth Anan, PhD, BCBA-D. Center for Human Development Division of Developmental-Behavioral Pediatrics. Meeting Name Meeting Date Meeting Location. Comprehensive Autism Assessment. I’m often the bearer of bad news.

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Insurance Coverage for Autism

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  1. Insurance Coverage for Autism Ruth Anan, PhD, BCBA-D

  2. Center for Human DevelopmentDivision of Developmental-Behavioral Pediatrics Meeting Name Meeting Date Meeting Location

  3. Comprehensive Autism Assessment

  4. I’m often the bearer of bad news • After conducting an interdisciplinary assessment, our team of doctors may confirm that a child has an autism spectrum disorder • Sometimes parents already suspect this and their fears are confirmed • On other occasions, the diagnosis may come as a surprise and parents are unprepared for this bad news

  5. Parents ask, ‘What would you do?’ • Intensive Applied Behavior Analysis (ABA) • Ample data demonstrating efficacy • Especially when treatment starts early • But there is limited availability of this treatment in Michigan • Lack of insurance coverage for ABA is more badnews for parents

  6. HOPE Center

  7. Beaumont’s HOPE Center • Opened in 2002 • GIFT (Group Intensive Family Training) Program • Intensive ABA for preschool children • Short-term, parent-training model • Small group format • Allows treatment to be more cost-effective • Gives parents sense of empowerment

  8. GIFT Program

  9. What does this treatment look like?

  10. There has been some good news • Our parent-training treatment outcome data were published in a peer-reviewed journal • A few insurances now cover GIFT Program • Beaumont Employee Health Insurance • BCBS of Michigan has a special rider • Several out-of-state insurances companies that already cover ABA treatment

  11. But there is still a lot of bad news • Although less expensive, parent-training still remains financially out of reach for many • Parent-training places a significant on-going burden on parents as the primary providers of their child’s treatment • For many reasons, intensive parent-training is simply not feasible for many families • They need professionally-implemented ABA

  12. Some more good news • In 2004 we added another treatment model • CARE (Children with Autism Reaching Excellence) Program • Delivers high-quality, intensive, professionally- • implemented ABA (for up to several years) • Preschool children receive individual therapy, but in context of small group setting

  13. CARE Program

  14. Yes, it’s effective, but... • It is cost-prohibitive for most families ($60,000/year for full time CARE Program) • Almost no insurance in Michigan covers this individual, intensive ABA therapy • Most parents “cut corners” by enrolling in CARE Program for only half-days when child’s condition warrants full-day treatment

  15. It won’t be good newsuntil it’s covered by insurance

  16. Michigan’s children need good news!

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