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Family Pushes for Autism Insurance Coverage

Family Pushes for Autism Insurance Coverage

By Caroline Vandergriff. CREATED Nov 8, 2012

Legislation to reform Michigan's insurance coverage for autism took effect in October, and it requires insurers to cover autism treatment and diagnosis. However, if a company is self-insured, it doesn't have to comply with the legislation.

Now Joshua and Amber Wortz are fighting for coverage, and they want to let others know they still have options to get the autism treatment their children need.

The parents say their five-year-old son Brayden is a happy-go-lucky kid who loves people and playing games.

"He's happy, funny. He loves puzzles," said dad Joshua Wortz. "Angry Birds is his favorite thing right now."

When Brayden was three years old, he was diagnosed with autism. His family's insurance initially paid for the treatments Brayden needed, but then the company cut off coverage. Luckily, Brayden's school provides many of the services he needs.

"If we weren't getting those services, we'd be paying out of pocket for speech therapy, private occupational therapy, and other services we could utilize," said mom Amber Wortz.

Therapy can run anywhere from $50 to $100 dollars for just one session, so the cost adds up quickly. That's why Amber and Joshua Wortz were excited when the state legislature passed the autism insurance reform package. The bipartisan bills require insurers to offer coverage for autism treatment.

However, Joshua Wortz works at Michigan State University, which is self-insured and does not have to comply with the legislation.

"So they're not, the law does not affect them," Joshua Wortz said. "So we're very disappointed in that."

"It's frustrating to know you're paying into something, and it can't be utilized for what you need it for," Amber Wortz explained. "We're relatively healthy people. We don't need insurance a lot, but now we do need it and it's not helping."

But the new legislation does include an autism coverage fund, which is designed to reimburse self-insured companies.

"So that's why we're working with MSU to give them that information, to realize that this is something they can offer to all their employees at essentially no additional cost to them," Joshua Wortz said.

It's a fight to make sure Brayden gets the help he needs, and the family doesn't plan on giving up.

"There's a lot of things that go into autism," said Joshua Wortz. "Unfortunately, it is expensive, but to help these kids get to what they need to be - to be good, functioning members of society - it's important to do it and to do it early on."

Joshua Wortz says the human resources department at MSU seems to be receptive to the idea of self-adopting the autism coverage. The university's joint health care committee will take up the issue at their next meeting on November 9th.

Amber and Joshua Wortz hope to raise awareness about the autism coverage fund, so that other families know they can get covered even if their employer is self-insured.

For more information on the new autism coverage law, visit: www.autismallianceofmichigan.org.