Searching for an option

Rutherfordton woman fights for autism spectrum disorder coverage
Jul. 14, 2013 @ 06:06 AM

Becky DeAntonio knows all too well about the value of good health insurance.

But, DeAntonio faces a problem that several families across North Carolina face … a lack of coverage for her son.

DeAntonio's son Lukas was diagnosed with autism spectrum disorder in 2012 at the age of 2.

Lukas had some therapy through early intervention but that stopped once he turned 3 this year, leaving DeAntonio without coverage for her son.

And the therapy Lukas requires isn't cheap. On the average, speech therapy costs $100 per hour, occupational therapy is $120 per hour and behavioral intervention therapy runs close to $45,000 per year.

"That's not even an option right now," DeAntonio said.

The DeAntonio family does have group insurance through an employer however it does not cover the care Lukas needs for his diagnosis.

So, Becky was elated to hear about House Bill 498 — a bill introduced during this year's General Assembly session — which mandated coverage of autism spectrum disorder through the state's insurance plan as well as some independent insurance providers.

That elation grew after the House passed the measure to the Senate by a 105-7 margin.

But, the elation quickly turned to angst as the bill languished in a Senate committee since May and will not be heard during this session.

"It leaves people like us in the middle class with no help in paying higher insurance when we keep getting denied coverage," DeAntonio said.

As the bill moved quickly through the House, DeAntonio was happy to learn the bill had a local spinor in Rep. Mike Hager, R-Rutherfordton.

But, again, that elation turned south after she learned Hager was one of the seven votes cast against the bill when it reached the House floor.

"When it was first explained to me, I didn't realize it was a mandate that would actually cost us money. No mandate can be free," Hager said. "I am against mandates and I think they hurt small businesses more than anything else."

While figures on the impact to small businesses weren't known, the legislative staff figured the bill would add $1.1 million in claims to the state employee insurance in the first year then $3.3 million in the second. The Autism Society of North Carolina (ASNC) figured the addition would cost health plan members $3.72 per year.

"It was going to effect small business owners and those that carry their own insurance," Hager said. "Folks are struggling, including small business owners and it is tough."

Nonetheless, the bill passed the House and moved into the Senate Insurance Committee where Sen. Tom Apodaca, R-Henderson, never placed the bill on the committee calendar, thus never holding a hearing or vote on the bill.

While Apodaca was not available for comment, he was reported in other news outlets as holding the bill because of unknown repercussions surrounding the Affordable Care Act. However, the ASNC said HB 498 exempts insurance plans affected by the Affordable Care Act. Those plans include plans subject to federal law such as plans operated by providers that are in more than one state.

"He said publicly, and to us, that he likes the bill and wants to try to get it passed in the short session," said Jennifer Mahan, spokesperson with the ASNC. "That is really good news and we want to work with him and address any questions or concerns he has about the bill."

None of that helped DeAntonio, who continues to struggle to find ways to get Lukas the therapy he needs on a regular basis.

"We have filed claims through early intervention but they have all been denied," DeAntonio said. "They say because he has autism and it is a developmental disorder, they don't cover developmental disorders."

She said Lukas would be able to get the therapy he needs if the bill were to pass.

"He is at an 18-month-old level with speech therapy. When he is not in therapy, he is more at a stand-still and it really holds every thing back," DeAntonio said. "Things that come natural for other kids, like eating with a fork, are challenging for Lukas."

As for now, the bill will likely not be heard during this session but can be revived for the 2014 Short Session. Until then, DeAntonio said she won't stop pressing for the bill.

"I will just keep talking about it and talking with local lawmakers about autism," DeAntonio said. "Occasionally I feel like giving up, like when this bill did not get heard but I have to get back up and not give up."