TRENTON Parents of children with autism told an Assembly committee today that state regulations governing insurance coverage for their children's treatment are so confusing they had to hire an attorney and medical billing expert to help untangle them.
"I'm a medical doctor and the issues with coding were so involved I had to hire someone to help me," Meredith Blitz-Goldstein, an oral surgeon, told the Assembly Financial Institutions and Insurance Committee.
After listening to complaints for nearly two hours, Assemblyman Gary Schaer (D-Passaic), the committee chairman, ordered insurance companies and disability advocates to revise the regulations and make them easier for families to navigate or else lawmakers would do it for them.
There will be a hearing convened six months from now, and for everyones sake I pray we have meaningful movement, Schaer said.
Gina Pastino, a pharmacologist from Montclair, said the quest to get her son treatment consumes so much of her time and money that she had to stop contributing to her retirement fund and delay treatment for her own chronic health conditions.
The amount of time that is required is so out of bounds and unreasonable, Ive had to take vacation days to take care of some of these things, Pastino said. I can appeal these claims one by one, but at some point something has to change. I am going to go out of my mind.
Ward Sanders of the New Jersey Association of Health Plans defended the insurance companies, saying the 2010 law only applies to state employees, teachers and members of state-regulated plans, like Horizon Blue Cross Blue Shield or the states small business and individual coverage plans , which account for about a third of New Jersey residents.
Sanders said the claims process is complicated because the American Medical Association has not created billing codes for applied behavioral analysis, the most widely used treatment for children with autism.
He urged the committee to withhold judgment on what youve heard today about these isolated cases because most (insurance companies) are complying with the law.
But Assemblyman Jack Ciattarelli (R-Somerset) questioned what families must go through to get their claims paid.
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N.J. law mandating autism treatment coverage needs work, parents and lawmakers say