Legislature Closes Loophole in Autism Insurance Law

In 2011, New York passed what was hailed as a landmark law regarding health insurance and autism. Basically, it forced insurance companies to cover care provided for children who had been diagnosed with autism in ways that they were attempting to avoid in the past. The passage of this law meant that thousands of families could suddenly afford different types of treatment that would provide those children with tremendous benefits that were simply not possible before this law was passed. Unfortunately, a little-known loophole was thrown into the bill that would turn out to have quite an effect on these families.

That loophole stated that insurance companies could deny coverage for treatments provided by a form of therapy that was known as Applied Behavior Analysis, or ABA, if the ABA provider did not possess a license in New York. That turned out to be quite a loophole, because New York does not have a license specifically for behavior analysts. Therefore, thousands of families were once again denied the therapy that they needed, as ABA had shown tremendous promise in children who had been provided with it in recent years.

Thankfully, news reports that aired on NBC New York shed light on this regulation that was attached to the bill just before it became law, and a public outcry followed. The media reported this week that this loophole has effectively been closed assuming Governor Cuomo signs the bill that has been passed by both branches of the legislature. There is no reason to think that he will not do so since he was a passionate champion of this legislation when it originally passed.

The loophole was removed because the bill now provides for a specific license in New York for behavior analysts. Taking this step now provides families with approximately 700 professionals across the state who will be able to treat their autistic children. It will also require insurance companies to pay for these treatments, which is in line with the original intent of the bill. As one could imagine, the insurance industry was less than pleased with this result, but families and advocates are relieved to have put this issue in the past.

People need to remember a few things regarding autism and insurance companies. The first is that treating autism properly costs tens of thousands of dollars per year. Secondly, people need to remember that insurance companies are for-profit corporations. Their bottom lines are determined at least partially by the amount that they pay out in claims. The fewer claims and the fewer types of claims that they have to pay, the better their bottom line will be at the end of the year.

We have been helping families fight against insurance companies as New York medical malpractice lawyers for 42 years. The team at The Fitzgerald Law Firm is happy to see that so many families will now have access to the type of treatment that they need for their autistic children.