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Oregon Insurance Industry Pushes Back on Autism Coverage
Another call to action for autism insurance coverage in Oregon from Paul Terdal:
• Update on SB365 – Insurers want a subsidy; threaten to sue Oregon if it enforces existing law
• ACTION #1: Call Governor Kitzhaber
• ACTION #2: Send an E-mail to Governor Kitzhaber
• ACTION #3: Send an E-mail the Ways and Means committee
Update on SB365 – Insurers want a subsidy; threaten to sue Oregon if it enforces existing law
I wrote last week that several insurance companies testified to the Ways and Means committee in support of SB365, the Autism Health Insurance Reform bill.
Unfortunately, Insurance Industry representatives are also demanding millions of dollars in taxpayer subsidies – and are even threatening to sue the State of Oregon if it attempts to enforce the existing laws that already mandate insurance coverage of autism treatment.
Oregon law has required insurance companies to cover treatment for autism since 2007 “at the same level as, and subject to limitations no more restrictive than, those imposed on coverage … for other medical conditions” (ORS 743A.168).
Despite orders by both State and Federal courts for Oregon; about twenty External Review decisions by Independent Review Organizations appointed by the Oregon Insurance Division; and numerous court orders in other jurisdictions around the country, most Oregon insurers (except Kaiser and PacificSource) flatly refuse to pay for medically necessary behavioral health treatment (Applied Behavior Analysis, or ABA) – and the Oregon Insurance Division refuses to enforce the law.
The principle behind SB365 has always been Autism Health Insurance Reform – we agreed to a clarification in the laws regarding autism coverage; the insurance companies would agree to comply with the revised rules; and the Insurance Division would agree to actually enforce them. I was abundantly clear in the legislative workgroup’s kick-off meeting more than a year ago that my agreement to participate in negotiations about new legislation did not excuse anyone from compliance with the laws that we already had.
The Insurance Industry is now arguing that SB365 represents a new requirement for autism coverage, and has even threatened to sue the State of Oregon if it attempts to enforce the laws we already have.
On Monday afternoon, we will be meeting with Sen. Bates, our chief sponsor; Insurance Industry representatives; and representatives from the Governor’s office, Insurance Division, and other departments to discuss the final draft of the legislation – and determine whether we can proceed at all.
It is absolutely essential to contact our elected officials to ask them for their support at this critical time.
ACTION #1: Call Governor Kitzhaber
Please take 1 minute on Monday morning to call Governor Kitzhaber’s office to ask him to support SB365, Autism Health Insurance Reform.
Call the Governor’s Citizen’s Representative Office: (503) 378-4582.
The phone will be answered by a staff member, or by voice mail. Here’s a message you can tell them – but feel free to personalize this:
My name is ____________.
I’m calling to ask the Governor to support SB365, the Autism Health Insurance Reform bill.
Oregon law has required insurance companies to cover medically necessary treatment for autism since 2007 – but most refuse to pay for the nationally accepted standard of care. Please enforce the law, and support SB365 to streamline access to coverage.
ACTION #2: Send an E-mail to Governor Kitzhaber
Please also send an e-mail to the Governor, using his web page: http://www.oregon.gov/gov/Pages/ShareYourOpinion.aspx
Step 1) Enter your personal information
Step 2) Choose "Health Care" in the "Topic" box
Step 3) In the comment box, say something like this:
Please support SB365, the Autism Health Insurance Reform bill, so that Oregonians with autism can get access through their health insurance to the treatments they need.
Oregon law has required insurance companies to cover medically necessary treatment for autism since 2007 – but they aren’t doing it. Please enforce the law, and support SB365 to streamline access to coverage.
SB365 clarifies existing requirements for health benefit plans, including private plans, PEBB and OEBB, to pay for medically necessary, evidence-based treatment for patients with autism. It would also create a licensing board within the Oregon Health Licensing Agency for providers of applied behavior analysis therapy, to ensure that patients receive quality, effective treatment from capable providers.
Every year, 600 more children are diagnosed with autism in Oregon. With effective, early intervention many of these children will be able to make substantial gains and require fewer services as they get older. Providing these individuals with the right care at the right time will save the state money.
Please support SB365. Thank you.
To make your message even more effective, add a few words about your personal situation.
ACTION #3: Send an E-mail the Ways and Means committee
Last week, I wrote to ask everyone to send an e-mail to the Ways and Means committee, asking them to support SB365. If you haven’t had a chance to do that yet, Autism Speaks has set up a really fast, simple form you can use:
Please forward this message to friends and family in Oregon who may want to send emails too. We’ll let you know how things are going, and what we’ll all need to do next.
Thanks for your help!