By JONATHAN BERR, who has written for national media outlets for more than 15 years.
Employees at The Autism Society, a small non-profit dedicated to raising public awareness about the condition, are offered a wide array of benefits -- except, ironically coverage for autism.
Maryland, where the society is based, doesn't require companies to offer the coverage.
"It's amazing," said Scott Badesch, the society's president and COO, who is lobbying state officials to change the law.
Maryland is behind the times. One in 88 children suffer from autism. Around 30 states have passed laws requiring companies to offer coverage for autism and services such as speech, occupational and behavioral therapies. These laws don't apply in general to large companies whose health insurance plans are self-funded. But even in those cases, there is progress as more of them are helping to cover the costs of these treatments.
"I am pleasantly surprised at the rapid growth of the number of companies that are offering autism benefits," said Lori Unub, vice president for state government affairs at Autism Speaks, adding that a German firm was basing its decision on where to locate its U.S. operations on whether a particular state required autism insurance coverage. "I actually cannot keep up with all the emails that I get. ... It is still the tip of the iceberg."
IBM, Capital One and Ohio State University are among employers that assist workers in paying for scientifically recognized autism treatments and therapies. IBM, the world's largest provider of computer services, offers a program to cover costs outside the scope of the company's health insurance plan. It has a lifetime maximum benefit of $50,000, according to the Armonk, N.Y.-based company. In addition, IBM provides LifeWorks, which offers around-the-clock personal phone support from trained disability consultants.
Capital One, the sixth-largest U.S. commercial lender by deposits, offers autism benefits because the company believes that it's the right thing to do, said Eric Gutierrez, vice president of HR benefits.
The McLean, Va.-based company offers coverage for applied behavioral analysis -- a common autism treatment that has been shown to be effective -- along with speech, occupational and physical therapy. It also funds and supports a program for autistic adults so they can experience what it's like to work in a Fortune 500 company.
"These types of benefits are definitely having a positive impact on hiring and retention," Guitierrez said. "We have several stories of associates whose decision to join our company were influenced by our great benefits, including the autism benefits. This is a tremendous retention tool for the associates using these benefits, as most would not be able to afford these services on their own. Many associates, even those without children with autism, have told us that the autism program speaks volumes for our values as an organization."
Spokesman for Facebook and Google confirmed that they offer autism benefits but declined to provide details.
Getting a handle on the costs associated with autism is tricky. They vary based on a variety of circumstances, including the particular nature of the diagnosis of the individual child. For some families, the expenses can be considerable. A report issued by the National Conference of State Legislators points out that some families may spend more than $50,000 a year on autism-related services. A 2006 Harvard School of Public Health study estimates that the costs society for individuals with autism is $35 billion. Unrub knows this data first-hand. Before her home state of South Carolina mandated that autism be included in health benefits, her family was spending more than $70,000 annually for her 11-year-old son, whose autism is considered to be severe.
"It was basically my whole salary," she said. "We were lucky."
Those figures don't tell the whole story. Data from Ohio State University, which began offering autism benefits in 1997 at the behest of employees, shows that compared with other conditions such as hemophilia, treating the disorder is not terribly expensive. Data from 2010, the latest year available, shows that autism accounted for 5.6 percent of behavioral health spending and 0.9 percent of overall health care spending, according to testimony it gave the Ohio State Legislature last year. Robert Meier, director of the Ohio State Employee Assistance Program, estimates that less than 100 employees use the benefit on annual basis.
"It has never exceed what I considered to be a threshold of concern," he said. "We spend more money on weight-loss surgery than autism."
Ohio State's costs are about 32 cents per member per month. On that basis, Autism Services Group LLC estimates treatment costs between $0.83 to $2.08 for the direct cost of care without adding-in administrative expense. Howard Savin, CEO of Autism Services Group, which advises insurance companies and companies on autism coverage, estimates the costs at $10 million to $25 million per year per million covered lives.
Given the increase in the appearance of autism, more companies likely will assist employees with these costs. Indeed, much of the cost growth will come from therapies being offered to pre-school aged children because experts argue that early detection is a key to successful autism treatment. Savin said that, over the long-term, this should push costs downward because this intervention may lessen the need for services as the child grows up.
"It is something they need to offer," he said. "There is clearly much more demand for these services than there ever has been in the past three or four years."
As more states enact autism coverage mandates, the costs of providing these services will be increasingly born by health insurance plans. One reason is that many parents of children with autism aren't accessing the benefits that they are entitled to receive may start doing so as awareness of these offerings increase.
"Parents are really just starting to use the benefits in a serious way," Savin said, adding that only 15 percent to 25 percent of people eligible for this help receive it. Many parents had received these services for free or if they were affluent paid for them themselves. Insurance companies also have done a poor job in publicizing the benefit.
"You have to be aware," Savin said. "You have to be knowledgeable."
Unfortunately, until scientists have a better idea of the causes of the disorder, figuring out who should bear its costs will be challenging. At least 30,000 children are diagnosed with autism in the U.S. every year, more than the amount of children diagnosed with diabetes, cancer and AIDS combined.
Though the risk may not be as expensive as some may expect, it is one that employers will need to address sooner rather than later.
June 4, 2012
Copyright 2012© LRP Publications