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Insurers urged to review autism treatment

February 25, 2009 12:00:00 AM PST
Joined by a consumer action group, the families of two autistic children issued an appeal to state regulators Wednesday. They are challenging health insurers, claiming autistic children are often denied proper medical treatment.Frank Nagle is 2 years old and autistic. He can also be violent to his little brother sometimes. His father has been fighting to get Frank the care he needs.

"We would have four 45-minute sessions for therapy for Frank," said Frank's father, John Nagle. "They would teach my wife and I ... a handout, how to give speech therapy. That's all we're going to get."

The father appealed to the Board of Independent Medical Review, and the board ordered Nagle's insurer, Kaiser, to provide treatment.

Before he started treatment, 3-year-old Andrew Arce wouldn't even look at a stranger. His family also had to battle their insurer.

"There's a lot of people out there that are hurting and that are begging to have these services for their kids," said Guillermo Arce, Andrew's father.

Consumer Watchdog says insurers are writing the rules to deny valid treatment to children. They believe the state and governor's office support the changes. A spokesman for Governor Schwarzenegger says the governor strongly supports the independent medical review process.

If the parents of autistic children lose the right to medical review they could be forced into court. Studies and experience show that delays in treatment can result in irreparable setbacks for autistic children.

Some parents and experts believe the therapy called Applied Behavioral Analysis can work wonders with children who have autism.

Charles Bachi of the California Association of Health Plans said that because it's a therapy, that does not make it medical. It is educational, not covered by insurance.

"If the healthcare service plans and the HMOs can get away with cutting off coverage and treatment for autistic children and their families, it's not going to be long before they do the same thing for people who have cancer or heart disease," said Harvey Rosenfield, Consumer Watchdog.

The families and consumer organization threaten to sue the state if needed autism treatment is denied.


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