I was under the (insert sarcasm here) impression that when the Affordable Care Act (aka Obamacare) was passed all of our lives when dealing with health insurance would improve. I also heard that costs would go down. I heard that out of pocket expenses, which previously could have driven you into bankruptcy, would be reduced.
Ok, nice utopian sales pitch, but we can all agree very little of that has come to pass at least if you have insurance of any kind before the thing passed. I do have a 52 year old single male friend who got word the other day that his plan now covers mammograms, he was happy about that (he is self employed and buys insurance privately and his costs went up for this new coverage btw).
Yes, it is easier for people with pre-existing conditions to get insurance. That is a good thing…at least I think so.
Yes, it is easier for people just coming out of college to get their start in life by staying on their parent’s insurance. This is probably a good thing because not as many of these folks are getting jobs much less one that offers insurance as a benefit.
Now, back to the topic at hand.
I have a son who is mildly autistic. To be specific, for those who also have such a family member (who we love very much, don’t get me wrong), he is an Asperger’s kid.
When seeking treatments for these children a few things are true. There are lots of different therapy options available now that weren’t around even ten years ago. Kudos to the medical professionals who came up with these, I love you guys for helping children like my son.
What these therapies do is ensure that these kids either come off the spectrum completely or they at least are able to cope with the differences between them and everyone else. There is nothing wrong with these kids they just process information differently and are shockingly different in social situations than other people.
We can all agree that person-to-person interaction is necessary when in the workplace. Without some measure of people skills careers grow stagnant, advancement is challenging, etc.
Why bring all this up?
My middle son (whose name is going to stay out of this) is in a variety of treatments, and they are helping a little.
There is one treatment left that all of his various doctors agree he needs…that is where this is problematic.
It is called ABA therapy. The ABA part is an acronym meaning Applied Behavioral Analysis Therapy. For kids like our son it is something that does wonders.
Two things are true, it is fantastic, and it isn’t cheap. It is recommended for his recovery but NOT covered by insurance; it is all out of pocket. It is at least $55/hour multiple hours a week at the LEAST. Then there are other periodic treatments/appointments that are more in the range of $110/hour. By periodic it is at least once a month (give or take). So it isn’t cheap.
Expenditures in the $500 per week range are no unreasonable to expect as a basic level.
So we call the insurance company…hey this thing our doctor is prescribing and saying “You need….”
They say, no that isn’t covered. You see that ABA is an analysis and not a treatment. So the name indicates we don’t cover it.
I asked the question, did you ever cover it.
They responded, we used to but are no longer required to do so.
So, let me get this straight, when did it change…
They responded, oh just a year or two ago as things were implemented for the new health care law.
Well, thank you ACA, I appreciate you throwing an additional $2,000 a month on me. Appreciate that along with the increased prices for insurance, co-pays, and all the other things you did to make life better.
Now in other areas, the coverage is different for the same insurance provider. I have a friend who has a mild to moderate Autistic son. They were lucky enough to get ABA covered in their region and the therapy has helped a great deal. The child is starting to speak out and interact with others. Their problem is it has been determined that his son needs more intense therapy, but because he is in his 4th year of ABA therapy, their hours of covered therapy went from 40 hours per week to 17 and the majority of that time has to be spent outside of structured therapy and in unstructured trips to different locations in their town.
Another challenge his family faces in dealing with insurance companies and ABA therapy is the local school system. Since each group/organization has to keep track of what services their son is getting, if there is any overlap, the insurance company will stop covering the ABA therapy. Anyone who has or knows a child on the spectrum knows for a fact, that these kids cannot get enough therapy. The more therapy they get at a younger age, the better off they are as they grow older and find themselves in mainstream situations.
Humorously (or not depending upon your perspective) I was told by the fine folks at one of the agencies that provide ABA therapy that if I made less money (ready for this)…that their services would be provided as a grant. Free of charge.
How is that for a fun day at the office?
I will continue to work hard and get my son all of the help he needs. I will also continue to fight for author autistic kids and make sure they get all of the help they need, one child at a time.
I know someone is going to say why should they cover it…blah blah…Ok I am with you. Let me explain it this way.
The cost of therapy for a few years when he is younger is much much less than the societal cost (or financial burden) someone who is unable to keep a job places on society and the taxpayers at large. Think of it as an investment. One I am willing to pay by paying the insurance company to cover things. Unfortunately they don’t so I would rather not pay them but thanks to the new federal law I get to keep this policy that doesn’t help. Awesome work Congress and other elected federal officials!!! Keep it up!