Wednesday, October 28, 2009

Kaiser's autism ruling

The way the LA Times framed it was
A tactic used by insurance companies to deny expensive behavioral therapy to autistic children has been deemed illegal by a Los Angeles judge.
In a preliminary ruling, Los Angeles County Superior Court Judge James C. Chalfant found that Kaiser Permanente's refusal to pay for a child's autism treatment because the provider was not licensed by the state runs counter to California's Mental Health Parity Act. That act requires insurers to cover care for mental and behavioral problems at the same levels they do for physical illnesses.
The treatment the parents wanted for their child was applied behavioral analysis (ABA). It is not clear to me whether ABA helps autistic kids or not. Wikipedia's editors aren't sure, either. There's a lot of wishful thinking among parents who desperately want a kid they can talk to, and there is no shortage of cheerleaders.

But the point I want to make here does not rely on whether ABA helps kids. Nor do I have any expert knowledge whether the judge correctly applied the law. I expect appellate judges will get their crack at that one.

I just wonder if it is good public policy to require insurers to pay for treatments by non-licensed specialists. If the issue is treating mental problems at the same levels they do for physical illnesses, is there any physical illness requiring a treatment as significant (and expensive) as ABA for which we do not require state licenses of the people who provide the treatment? We require licenses to treat appendicitis, and schizophrenia, and to sew up cut fingers. We require a license to braid hair, to drive a car, or cut fingernails, for Christ's sake.

Regardless of whether an insurer has to pay for it, doesn't somebody at the state license these therapists? They're screwing around inside kids' heads, and we let anybody with a website do it? And not just that, but if they can convince the parents that it's good therapy, the insurer has to pay for it? They can't even require the parents to take the kid to a state-licensed therapist?

I can understand the reasoning for allowing unlicensed providers do APP child care, but this, this is just crazy. Nobody would build a system like that. I wonder what I'm misunderstanding. (That's often what it means when I think somebody is just crazy.)

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