Patient advocates called on state regulators Tuesday to force health insurers to cover certain autism treatments.
Consumer Watchdog in Santa Monica sent a letter to Cindy Ehnes, executive director of the state Department of Managed Health Care, and her boss, Gov. Arnold Schwarzenegger, expressing concern about delays in resolving coverage complaints from parents of autistic children.
The parents say insurers are refusing to cover needed behavioral therapy for their children. But, the parents say, when they took their complaints to the department, it sat on them for months.
Consumer Watchdog founder Harvey Rosenfield said in the letter that state laws require the department to take swift action on the parents' complaints and that delays could exacerbate the children's condition.
Autism is a disorder that impairs communication and socialization. Its cause is unknown. There is no cure. But experts and public health authorities say that the disputed behavioral therapy is effective, especially when started at an early age, at mitigating symptoms and improving self-sufficiency.
The department had been sending disputes over the treatment to panels of independent physicians. Increasingly over the last year, those panels had been deciding that the treatments were medically necessary, and the insurers were made to pay.
Then, late last year, Kaiser Permanente, the state's largest nonprofit health insurer, changed its rationale for denying the coverage.
Instead of saying the treatment is not medically necessary, Kaiser now says the therapy is not covered because it is educational and not medical.
The new tactic prompted the department to put several treatment disputes on hold while it considered how to respond.
"The proper handling of Independent Medical Reviews for autism coverage has been a high priority for the DMHC, and the issues in these cases are highly complex, as are most issues concerning autism," said Department of Managed Health Care spokeswoman Lynne Randolph.
"Children with autism and their families deserve a complete examination by the DMHC of all complexities of these cases, which is what we have been providing," Randolph said.
The department's reconsideration of the disputes stoked concern among parents and patient advocates that it might allow insurers to avoid covering the treatments.
Rosenfield threatened to sue the department if it retreated.
