Traverse City Record-Eagle


April 17, 2011

Autism treatment expensive in Michigan

Limits on insurance coverage, scarce resources leave some families struggling

TRAVERSE CITY — Physician Sara Wine makes a good living by most standards.

But even she can't afford to pay for her son's autism treatment in Michigan.

"In Michigan autism isn't considered a medical diagnosis so insurances don't cover services," said Wine, a former Traverse City practitioner who moved to Indianapolis four months ago to get better services for her son, 3. "We tried for about two years to maximize services in Michigan, but all the good services and good providers have fled Michigan because they couldn't get paid, and you have to pay for your services out of pocket."

An autism diagnosis hits 1 in 110, and more families are struggling with the worry and expense of finding treatment and special education for children with the complex developmental disorder.

It can cost $3.2 million to take care of an autistic person over the course of a lifetime, according to a Harvard School of Public Health study. Direct medical and nonmedical costs alone can add up to as much as $67,000 a year or more, depending on the level of disability.

That figure includes medical costs like doctor visits, prescriptions and occupational and speech therapy, as well as expenses for things like special education, camps and child care.

Many health insurance policies do not cover autism treatments, while those that do often have severe limits. Treatment is individualized so insurance companies have few uniform protocol standards to follow. That means parents often have to lobby for certain therapy or treatment.

Many, like applied behavioral analysis (ABA), a common autism treatment, are considered by insurance companies as "experimental," though ABA and others are supported by scientific bodies like the Surgeon General and the American Academy of Pediatrics.

Out-of-pocket costs soar

In Michigan, Wine said she paid $80,000 out-of-pocket over two years for evaluation and treatment of her son, including all of the above plus behavioral therapies, physical therapy and supplements. In Indiana, even his doctor's visits are covered by her HMO.

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