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May 1, 2009
With so many grim headlines dominating the news, I wanted to take an opportunity to tell you about an area of policy I’ve dedicated a lot of time to this session that impacts many Maine families on a very personal level, and you probably haven’t heard much about it. As many of you know, family is what matters most to me, and over the past four years, I have learned so much more about the challenges Maine families face.
Between my work with local foster families as a past board member of SMART Child and Family Services, and becoming a new grandparent last year, I have become acutely aware of the importance of early childhood development. As I have researched the related issues, I was shocked to learn that insurance companies in Maine do not have to cover services related to the diagnosis and treatment of several illnesses and disorders, most notably Autism Spectrum disorders and other pervasive developmental disabilities.
If you had asked me this time last year to explain to you the characteristics of or treatments needed for children living with Autism, I couldn’t have told you much. No one in my large extended family has had any experience with it. But when I learned that there were parents spending much of their time fighting with insurance companies about getting the coverage they thought they were paying for, I felt compelled to do something about it.
It turns out that a state senator from York County, Sen. Peter Bowman, was hearing a lot on the issue from parents living in his district. We both submitted similar legislation, and over the last four months, have spent countless hours together talking with parents, advocates, service providers and officials from the Maine Bureau of Insurance to gather data, compile evidence and help work toward a solution.
As we researched the issue, we learned something interesting. It’s not that insurance companies aren’t paying for any services, it’s that Autism Spectrum disorders and pervasive developmental disorders require such a range of treatments or therapies that insurance companies often neglect to consider what full coverage actually means. Some classify ASD as a mental illness, others as a neurological condition, and still others as developmental behavior patterns. What I’ve heard from parents and young adults impacted by Autism is that care and treatment is required for all of these areas.
Providers of developmental disorder treatments told a similar story, but with details that indicate that many insurance companies do not have a universal approach to how they code services for billing. One provider told me that if she submits a bill for treatment listed under one code, it can be denied, but if she resubmits as something else, it’s covered without a problem. The next month, she said she’s been denied for what had previously been covered. However, a patient receiving the same services under MaineCare typically is not denied, because MaineCare already has a system in place to support children with Autism and pervasive development disorders.
It seems truly unfortunate that the high cost of care not being covered by insurance companies lead many families to become dependent on MaineCare, and taxpayers begin assuming the burden of care, simply because of an insurance company’s coding system. These struggles are enough to drive many providers out of business, and cause parents already working hard to care for their children to devote a lot of energy to appealing claims.
The Legislature’s Insurance and Financial Services Committee agreed with our coalition’s assertion that something needs to be done, and has referred mandating insurance coverage of Autism diagnosis and treatment to the Bureau of Insurance for review. This is a very positive step forward for Maine families.
Building on that success, Sen. Bowman and I have approached the Legislature’s Education Committee to address another issue we heard from parents – that many classroom teachers need better training on working with students with special needs like those with Autism. We have submitted legislation for the Department of Education to come back with more information about what is currently available for teachers, and determine if more education can be made available through special education departments in schools throughout the state.
This proposal is still awaiting approval, but working with families and providers on this issue has been eye-opening to say the least. I am pleased that we have made some progress and started a dialogue that will hopefully yield good results for both the families impacted and for the rest of the state. If you want to learn more about my efforts on this legislation or any other state issue, please feel free to call me at home at 892-6591, or e-mail me at Rep. Bryant.