Politics & Government

Lawmakers lecture insurance companies about paying for autism treatments

FRANKFORT — Legislators told the state's insurance companies Tuesday to work with parents of autistic children to ensure that legitimate claims are being paid, as required by a bill lawmakers approved three years ago.

If continuing payment snafus are not resolved before the legislative session begins in January 2014, the legislature may consider making tweaks to the law, said Sen. Tom Buford, R-Nicholasville, and co-chairman of the Interim Banking and Insurance Committee. He said one possible change would be to require insurance companies to meet quarterly with providers or parents who have problems getting paid.

"There is no reason why we can't get this worked out," said Rep. Jeff Greer, D-Brandenburg, after the two-hour hearing to discuss problems with implementation of the law, which requires large insurance plans to pay for autism-related treatments.

Greer, the other co-chairman of the committee, was a primary sponsor of House Bill 159 in 2010.

"My goal is to make sure that these parents receive benefits and there are no more complications," Greer said.

The bill, which took effect in January 2011, required large group insurance plans to pay up to $50,000 a year for autism-related therapy for children ages 1 to 6 and up to $12,000 a year for people ages 7 to 21. It also required coverage of a costly therapy called applied behavioral analysis, an intensive one-on-one therapy that uses behavioral techniques to teach children skills.

Parents of autistic children told the committee Tuesday that some people still are not receiving reimbursements for services. For example, parents of children at the Highlands Center for Autism in Prestonsburg, the only applied behavioral analysis center in the state, have struggled to get insurance companies to pay for treatments provided by the center.

The Lexington Herald-Leader first highlighted problems with implementation of the insurance law in April.

Tyler Hall told lawmakers Tuesday that he moved from Lexington to Prestonsburg so his two children, ages 4 and 2, could get treatment at the center. Hall said his insurance claims have been repeatedly denied for a variety of reasons.

"I have received zero dollars from insurance," Hall said.

Meanwhile, his 4-year-old son has gone from being non-verbal when he started Highlands two years ago to mastering more than 300 vocabulary words. He's on track to attend kindergarten, something Hall said he never thought possible two years ago.

Representatives of Anthem and Humana told the committee that it took time for them to implement the complicated change. In addition, they said autism service providers rarely billed insurance companies before the change, meaning the providers had to learn how to correctly bill insurance companies.

Rep. Sannie Overly, D-Paris, said she has been told by constituents who have autistic children that some insurance companies still aren't reimbursing for applied behavioral analysis provided on an outpatient basis.

Overly said one family in her district has had claims denied by three insurance companies that were required under the law to pay for applied behavioral analysis. The child's grandparents have had to pay for the therapy, she said.

She called HB 159 a great piece of legislation, but said "I don't think our work is done yet."