Colorado

Dec 2, 2013 11:44 PM by Maddie Garrett

Parents Protesting New Insurance Rules for Autism Therapy

Hundreds of Colorado families who have children with autism could have a new hope when it comes to getting critical therapy for their children. It all started after News 5 uncovered shortfalls in our state's new insurance rules that deal with Applied Behavior Analysis (ABA) therapy.

Cari Brown was one of the parents who attended a meeting at the Colorado Division of Insurance Monday afternoon, to fight for her son. She moved to Colorado from Utah in May, in hopes of getting insurance that covered ABA therapy for her son with autism.

"Without the laws to protect us there's just no coverage for treatment," explained Brown.

But now that coverage she moved for, is being stripped away.

"I just cried and cried and cried, wondering what is going to happen," said Brown.

Here is what is actually happening: After the Affordable Care Act abolished lifetime dollar caps on treatments, the Colorado Division of Insurance changed its rules for autism therapy. Instead of a $34,000 a year a cap, it's now set to 550 sessions a year at 25 minutes each.

Parents tell News 5 that's less than half of what they used to get.

"I have nothing left other than just to cry and pray that they will change the limits," said Ramona Smith.

News 5 first told you about Smith and her two boys with autism a month ago, now she's ready to leave Colorado over this.

"I am so desperate that I'm actually looking at other states, I am actually willing to move just to get ABA therapy," said Ramona at Monday's hearing.

She's looking at other states because about six states interpreted the law differently and got rid of limits on autism therapy altogether.

"But in terms of the visit limits and things, Colorado is in the minority on that," said Dan Unumb, Executive Director of the national organization, Autism Speaks.

Unumb said he believes the Division is misinterpreting the Affordable Care Act laws.

"That was the whole purpose of saying we're not going to have dollar value limits on essential health benefits. To simply take that and say "I'm going to use a session limit, based on the dollar value," is improper and contrary to the statute," he explained.

During the hearing, Colorado Insurance Commissioner Marguerite Salazar pointed out that the sessions are not a limit but a minimum. However, that wasn't reassuring to those in attendance of the hearing.

"I have never seen an insurance company that has gone over the dollar cap. So there would be no reason to suspect that when there is a session or a visit limit that insurance companies would go over that amount either," said Unumb.

The Division of Insurance will continue to take written public comment on this for the next five days, but after that it's unclear what they'll do next.

Salazar said at the hearing, "We really need you to come forth and let us know, so we can do that type of investigation."

The investigation is now underway, but will it mean change for these families?

"Obviously we are hopeful that they'll realize, you know, how devastating this could be to the autism community," said Brown after the hearing.

Salazar couldn't give News 5 a timeline on if or when changes would come. Even though the Division previously said the autism therapy rules wouldn't change for 2013, Salazar said even that isn't necessarily set in stone. News 5 will continue to follow up on the Division's decision.

 

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