Tuesday, July 08, 2008

Let's Talk About Insurance, Shall We?

Always a bad mistake to be tempted into reading AutismVox. Not because she doesn't have some of the most balanced, insightful and thought provoking things being written about autism in blogdom, of course she does; but simply BECAUSE they are insightful, balanced and yada yada, I then have to spend all my time thinking about that topic!

Well THIS ONE was no exception, because it's about one of my favorite rants: insurance coverage for autism services. We are roughly in the same position as Kristina/Charlie but a few years behind in that Liv is probably going to need services and assistance in some way for life, so the idea of 'medical necessity', when it comes to insurance coverage, comes into our vocabulary frequently. The idea of therapy, in the minds of an insurance company, is a repair/recovery-then-back-on-the-street sort of thing; physical therapy on a broken leg and get it back to working order in 6 months and they're done. But what if repair/recovery is not '90% mobility' definable? What if timetables of therapies are not measured in weeks and months, but months and years?

I really think we are at a crossroads of services for the disabled and who should pay for them. If you recall, the private sector predicted the end of civilization as we knew it when they were told what the Americans With Disabilities Act would really mean. "Making the country disabled-accessible would be cost prohibitive and would not float; the economy will sink, small business would cease to exist and the county's economy would wind up at the bottom of the fiscal ocean" according to those in business. Well, 15+ years later the dingy is still bobbing and we have an unprecedented awareness and diversity and access in the workforce and in public places. Well, OK, so it's not as rosy as all that, but going from nothing to a little is still unprecedented!

Not only has the private sector bore the burden of legislative disability access, but the public sector has as well, perhaps more, especially at the local school level. It has gotten to the point where not only are schools specializing their education for special needs kids, but they are providing therapies as well. No one in the late 70's would have expected their child to receive speech, physical or occupational therapy from a school system; today, it is commonplace and required. Again, rosy picture, thorny reality, but let's go with it.

So, here we all are at the crossroads of the next 'disability' intersection, that of neurological differences. Science is providing more detailed information about disorders and their potential therapies. Government is signing laws to have these disabilities provided for. Localities are trying desperately to provide these services. Parents are trying to fill in the gaps left in therapies that they see as still needed but not provided. And in the distance we see the devil incarnate in the form of the insurance industry quietly walking away from the intersection whistling and counting the souls he has stolen, looking over his shoulder to make sure no one's the wiser.

Don't get me wrong, I'm not one of those 'socialize medicine' types (well, actually, I am, but besides the point), but I just have this funny idea that insurance is there to protect me from devastating medical losses. Maybe I'm old fashioned, but I consider helping my child communicate and learn how to better use her body to be part of that protection; I'm sorry, but I don't buy that this is a cost that should be borne by society. From what I've heard, using the excuse that schools should be providing these types of services is illegal (citing from the law firm of Dewey, Cheatham and Howe which was recently bought out by the firm Burnham and Ruhn). But, behind closed doors, they are saying that this is society's burden, not theirs.

Now you know I'm no where near being a defender of insur-a, but maybe they DO have a point. We have insurance, schools, state and federal entities passing this very expensive hot potato around. If autistics are integrated into society through better therapies and services, who's the primary beneficiary? State and federal governments will benefit in the form of a more productive citizen. Families will also benefit because they will bear less of the support burden. So why should insurance get involved in this when they are not the beneficiaries? Let's leave the leg broken, let's not provide preventive checkups; let's not attempt to take people where they should or could be; let's leave all that up to the people and entities most impacted. Fact is that insurance bears a primary obligation to the insured and a secondary obligation to it's stockholders and not the other way around (at least in my socialistic mind). I know I'm straw-manning it a little here, but I just feel that insurance will do anything in their power for cost avoidance; if you don't believe that, your mom or your spouse probably deals with your insurer.

What do we do then? How do we weave this safety net with government and private sector thread to catch poor unfortunates like my family just trying to give my daughter the life she deserves? I haven't a clue, but if the past is any indication, this battle is over money so it's going to get bloody. The only question is whether it remains a guerrilla war, where insurance and governments silently cut and run and work the denial of services covertly; or whether we can drag this out into the light and have a proper fight.


Marla said...

This is a hot topic and so very stressful to us as parents. We have had terrible coverage in the past that has made us give up a larger home for our now very tiny home. Now, we have better insurance that is opening up services for us we never even knew existed. Or at least we are praying that it will happen. (waiting for a possible thearpy day school).

I think the red tape involved in getting coverage is terrible. It seems too that when we are at our most tired and worn out the insurance companies refuse to cover the treatments/hospital stays or whatever and I barely have any energy left to fight with them. Sigh.

Maddy said...

I'm tempted to copy and send out DVD's of 'Sicko' which seems like compulsory viewing to me.

Just about everything is out of pocket or out of network or out of whack.

Insurance is a business, there's no way round the profit margin.

Best wishes


Aside from my wife's 'other' full time jobs (therapist, services coordinator, taxi driver, researcher, MOTHER), fighting for every dollar and service is another job that can pay very well if you have the time patience and intestinal fortitude.

Just another one of those fantasy jobs I'd like to create- insurance coordinator/bulldog!