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NC Lawmakers Look at Expanded Coverage for Autism

Photo: More than 14,000 children in North Carolina are diagnosed with autism. A bill before the State Assembly would require insurers pay for a limited amount of treatment. Photo credit: tangle eye/morguefile.com
Photo: More than 14,000 children in North Carolina are diagnosed with autism. A bill before the State Assembly would require insurers pay for a limited amount of treatment. Photo credit: tangle eye/morguefile.com
June 3, 2015

RALEIGH, N.C. - Almost 14,000 North Carolina children are diagnosed with autism, according to the Centers for Disease Control and Prevention, and those children aren't guaranteed coverage for their treatment. It largely depends on their insurance provider, but a bill passed in the State Senate and on its way to the House would provide insurance coverage of autism spectrum disorders for physician-advised treatments.

David Laxton, director of communications for the Autism Society of North Carolina, said it's a matter of inequality for families covered by insurance policies that don't voluntarily cover autism treatments.

"It's a real cost issue for families," he said, "and it's also a fairness issue because you pay in for your health-care premiums, and what has been getting in the way of treatments is because autism has been looked at differently than other conditions."

If Senate Bill 676 passes, the coverage would be similar to the state employee health plan that began offering coverage in January. Benefits would be provided through age 18 and be capped at $40,000 a year. The House is expected to take on the issue next week in committee. The national advocacy group Autism Speaks supports broader autism insurance coverage and estimates the average increase to a policy holder to be about 31 cents in North Carolina.

Laxton said the current system for people without autism coverage on their policy is a maze of red tape.

"Somebody may be eligible for x-number of visits to a speech or an OT therapist before they have a diagnosis of autism," he said. "Once the diagnosis comes through, then that changes what they're eligible for."

Thirty-seven states and Washington, D.C., have laws related to autism and insurance coverage.

The text of SB 676 is online at ncleg.net.

Stephanie Carson, Public News Service - NC