[Note: Shared for #AutisticHistory archive purposes. This is NOT An Autistic Ally.]
Federal Judge Removes Key Roadblock To ABA Insurance Coverage
August 13, 2014
PORTLAND, OR (August 13, 2014) — A “developmental disability exclusion” widely used by insurers to deny claims for applied behavior analysis (ABA) therapy for autism has been rejected in Oregon by a federal judge as a violation of federal and state mental health parity law.
Ruling in a class action lawsuit brought against Oregon’s Providence Health Plan, U.S. District Court Judge Michael Simon ruled that “an insurer cannot provide coverage for a service for one child and deny coverage for the same service for another child solely because the second child suffers from a developmental disability.”
The complaint, A.F. and A.P. v Providence Health Plan, was brought by two families raising children with autism and was certified as a class action covering all Providence policyholders earlier this year.
Simon ruled that the blanket exclusion violated the federal 2008 Wellstone Domenici Mental Health Parity and Addiction Equity Act, Oregon’s Mental Health Parity Act and a 2007 Oregon statute regarding medical coverage for autism. According to the decision, “Providence cannot simultaneously purport to cover autism and yet deny coverage for medically necessary ABA therapy through its Developmental Disability Exclusion consistent with the Oregon Mental Health Parity Act.”
Simon also made clear he considers ABA to be medical treatment, as opposed to a service provided by schools.
“The case is significant in holding that developmental disabilities exclusions are prohibited as ‘separate treatment limitations’ applicable only with respect to mental health benefits,” said Dan Unumb, executive director of the Autism Speaks Legal Resource Center. “The case is also useful in its discussion of other treatment limitations, such as ‘experimental’ exclusions and ‘medical necessity’ exclusions that are often more restrictively applied to exclude ABA coverage for autism.
“Finally, it is important just for making clear that coverage of ABA treatment for autism is a benefit with respect to a service for a mental health condition covered under mental health parity,” he said. “Even if autism or related treatment may also be characterized as “developmental,” this does not in any way remove this condition from the protections of the mental health parity act.”
In the course of the litigation, questions arose over the enforcement practices of the Oregon Insurance Division. External review boards over the course of several years ordered private insurers more than 20 times to cover autism treatment, but the state agency failed to enforce compliance, as reported by Willamette Week.
The report cited efforts by Paul Terdal, an Autism Speaks volunteer advocate, to improve the state’s enforcement efforts.
The Autism Community Is Not The Autistic Community
Autistic people have fought the inclusion of ABA in therapy for us since before Autism Speaks, and other non-Autistic-led autism organizations, started lobbying legislation to get it covered by insurances and Medicaid.
ABA is a myth originally sold to parents that it would keep their Autistic child out of an institution. Today, parents are told that with early intervention therapy their child will either be less Autistic or no longer Autistic by elementary school, and can be mainstreamed in typical education classes. ABA is very expensive to pay out of pocket. Essentially, Autism Speaks has justified the big price tag up front will offset the overall burden on resources for an Autistic’s lifetime. The recommendation for this therapy is 40 hours a week for children and toddlers.
The original study that showed the success rate of ABA to be at 50% has never been replicated. In fact, the study of ABA by United States Department of Defense was denounced as a failure. Not just once, but multiple times. Simply stated: ABA doesn’t work. In study after repeated study: ABA (conversion therapy) doesn’t work.
What more recent studies do show: Autistics who experienced ABA therapy are at high risk to develop PTSD and other lifelong trauma-related conditions. Historically, the autism organizations promoting ABA as a cure or solution have silenced Autistic advocates’ opposition. ABA is also known as gay conversion therapy.
The ‘cure’ for Autistics not born yet is the prevention of birth.
The ‘cure’ is a choice to terminate a pregnancy based on ‘autism risk.’ The cure is abortion. This is the same ‘cure’ society has for Down Syndrome.
This is eugenics 2021. Instead of killing Autistics and disabled children in gas chambers or ‘mercy killings’ like in Aktion T4, it’ll happen at the doctor’s office, quietly, one Autistic baby at a time. Different approaches yes, but still eugenics and the extinction of an entire minority group of people.
Fact: You can’t cure Autistics from being Autistic.
Fact: You can’t recover an Autistic from being Autistic.
Fact: You can groom an Autistic to mask and hide their traits. Somewhat. … however, this comes at the expense of the Autistic child, promotes Autistic Burnout (this should not be confused with typical burnout, Autistic Burnout can kill Autistics), and places the Autistic child at high risk for PTSD and other lifelong trauma-related conditions.
[Note: Autism is NOT a disease, but a neurodevelopmental difference and disability.]
Fact: Vaccines Do Not Cause Autism.