FRANKFORT Tyler Hall's autistic 2-year-old son could speak only a few words in January 2012 when he entered the Highlands Center for Autism in Prestonsburg.
More than a year later, the 3-year-old has learned dozens of new words and can dress and feed himself. His parents also can do something new: "We can go out to eat," Tyler Hall said. "None of this would have been possible without the center."
But the Halls and a dozen other parents of children attending the Highlands Center are struggling to get their health insurance companies to pay for treatment of their children three years after a state law was passed that requires large insurance plans to pay for autism-related treatments.
"The amount of effort used to try to get around what they are supposed to do is mind-boggling," said Hall, who moved from Lexington to Prestonsburg so his son and now his nearly 2-year-old daughter can attend the Highlands Center. "It's an injustice to these families and to the center."
When the General Assembly passed House Bill 159 in April 2010, Kentucky became one of 17 states that mandate insurance coverage for treatment of autism, a spectrum disorder that is characterized by impaired social interaction and communication skills.
The bill, which took effect in January 2011, required large group insurance plans to pay for autism-related therapy up to $50,000 a year for children ages 1 to 6 and up to $12,000 a year for kids ages 7 to 12. In particular, it required coverage for a costly therapy called applied behavioral analysis an intensive one-on-one therapy that uses behavioral techniques to teach children skills.
"It made everyone feel really great," said Shelli Deskins, director of the Highlands Center. "The legislators, the providers, families and everyone involved thought this would finally help kids with autism. But there are still families that are trying to get reimbursed for something that this law entitles them to."
In particular, insurance companies have balked at paying for services in an institutional setting such as the Highlands Center and the Academy at St. Andrews, a private school for autistic children in Louisville. Generally, insurance companies are not required to pay for treatment that is viewed as educational rather than medical.
"It's a loophole in the law," said Dr. Mark Miller, whose autistic daughter attends St. Andrews.
The school does not bill insurance for treatment, but Miller and his wife who also is a doctor tried to submit claims to Anthem Blue Cross and Blue Shield and United Healthcare for their daughter's treatment at St. Andrews.
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Parents of children with autism fighting for insurance payments in Ky.