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Friday, August 22, 2014

A Forum in South Dakota

In Sioux Falls, SD, the Argus Leader reports on a public forum about insurance coverage.
Some spoke of their surprise to learn that Wellmark, the state’s biggest insurer, would be dropping its coverage of the ABA therapy. The therapy costs more than $100,000 a year.
“We’re a middle-class family. If you’re an autism family, you’re going broke fast,” said Richard Zeck, a Brookings resident whose 12-year-old son lives with the disorder.
Zeck said his family lived 11 years in North Dakota, where state policy mandated generous coverage of applied behavioral analysis, then moved to South Dakota, where there was no help.
“The difference is appalling,” he said of the two Dakotas.
Dr. Tim Gutschall, chief medical officer for Wellmark in Des Moines, then addressed the group. He listed several forms of less intense autism therapy that Wellmark covers, then told why Wellmark does not cover the ABA therapy.
Autism is not entirely a medical issue, but also an educational issue, and the ABA therapy has had inconsistent results, he said. He asked why coverage should be mandated when the science is changing so fast.
With that comment, Ron Larson, hurried back to the microphone to scold Gutschall.
“We’re not here to be lectured,” Larson said. When insurers such as Wellmark take a position on legislation, “they’re going to make money off it,” he added.