GREENSBORO, N.C. -- North Carolina parents and organizations have fought for years to require insurance companies to cover autism treatments, which can costs families tens of thousands of dollars a year.
Forty-two states plus the District of Columbia and U.S. Virgin Islands have already enacted autism insurance reform laws, according to the national advocacy group Autism Speaks.
North Carolina legislators are currently considering Senate Bill 676. It would require large-group health plans to offer coverage for autism treatments.
In documents provided by the Autism Society of North Carolina, proponents of the bill explain the proposed benefit takes a balanced approach by placing a financial cap (a quantitative limit) of $40,000 per year on this autism behavior benefit.
SB 676 passed the Senate with a nearly unanimous vote in May, passed the House Insurance Committee in June, and is currently in the House Rules Committee.
But some parents have concerns with the way part of the bill is written.
Attorney Brian Pearce and his wife live in Greensboro with their two kids. Brian says recommended autism therapies have dramatically helped his son’s behavior and speech.
“There are more and more scientific studies that this stuff works. I can tell you from my personal experience it does,” Pearce explained. “Autism is a mental illness. It’s supposed to be covered by mental health parity law.”
Mental health parity protections make sure large group insurance coverages for mental illness are no more restrictive than treatments for physical health problems.
“Autism is a mental illness under North Carolina law,” said Pearce, referring to the state’s Diagnostic and Statistical Manual of Mental Disorders. "But if the new law is passed, there will be an exclusion for autism. That really makes no sense because it’s completely recognized countrywide if not worldwide that autism is a mental illness.”
He and about 60 other families sent a letter to lawmakers expressing their concerns.
Pearce says if the bill passes as is, they are worried insurance companies could require them to try a range of therapies before agreeing to cover recommended ones. Or that their current providers may not be covered by insurance.
“Insurance companies could say, ‘We just want to have one person who’s giving these therapies in the state.’ Typically you could go to federal law and the mental health parity rules and your argument is to say insurance companies --you can’t do that. However, if this bill passes as is, we wouldn’t be able to do that.”
The Autism Society of North Carolina supports SB 676 and, in statements the group provided to FOX8, they argue the bill does not remove parity protections.
“The bill does exempt autism spectrum disorder from the list of mental health disorders in Section 58 of NC’s insurance laws. This definition only applies to insurance coverage and specifically to the coverage for adaptive behavior treatment. Without this change, insurers cannot add a behavioral benefit that has a $40,000 yearly limit," said ASNC.
The statement goes on to say, “To repeat, parity applies to all other health insurance benefits, except Adaptive Behavioral Treatment, which is carved out. The change to who is covered under mental health parity does NOT prevent people with autism from having parity for all other mental health and physical health benefits. People with autism will still be able to see a doctor, get physical therapy, see a psychiatrist or counselor, or get inpatient treatment for mental health problems.”
ASNC says they consulted with policy makers, experts and attorneys and are certain parity protections are in place. “Families need coverage now and SB 676 is a good bill,” they stated.
Liz Feld is the president of the national advocacy group Autism Speaks. She said in an email statement, “We stand with the families of North Carolina. We urge the legislature to pass the pending autism insurance legislation as soon as possible to help our families with the staggering cost of autism therapies. We remain concerned about carving autism out of the definition of ‘mental health condition’ because that designation comes with protections. Moving forward, we will work to ensure that mental health parity protections are available for all in North Carolina and around the country.”
Pearce says he and other families do not agree with ASNC’s evaluation of the impact of SB 676. Pearce said he and other experts have suggested alternate language for the bill that he believes would protect parity rights and ensure caps are enforceable, but they haven’t heard back yet.
“This shouldn’t be what our government is doing. They should be looking out for these kids. It isn’t a partisan issue. These kids already have some obstacles to go through growing up. Why are we making it more difficult on them and their families to get therapies we know work?”