Friday, December 23, 2005

Let me start from the beginning


My name is Lorri Unumb. I am a law professor and the mom of a 4-year-old child with autism.

I started this blog to provide information to folks interested in helping pass legislation that would require insurance companies to cover autism treatments that are prescribed by a doctor. A few other states have similar legislation, and families in South Carolina deserve the same level of coverage.

Below is a letter I sent to some families who are privately paying for ABA therapy for their children with autism. I will attach some other items of interest. If you would like to help, please contact your legislator and ask him/her to co-sponsor this legislation. The bill number in the House is H.4351 and the number in the Senate is S.958. Thanks!

Dear Family:

My name is Lorri Unumb, and I am the mother of a 4-year-old son with autism who receives ABA services. I am also a law professor at the Charleston School of Law; I previously taught at George Washington University Law School in D.C. and practiced law at the United States Department of Justice.

I write today to ask for your help on some autism legislation in South Carolina. Based on my personal experience, I assume that most of you are privately funding your child’s ABA program with little or no assistance from the schools, Medicaid, or your insurance company. My insurance company, CIGNA, has a written internal policy (see attached) explicitly disallowing coverage for ABA. If you have filed ABA claims with your insurance company, you may have received denials on a variety of grounds, such as “experimental treatment,” “educational rather than medical treatment,” “non-licensed provider,” or “subject to mental health exclusion or limitations.”

Over the summer, I started to research insurance coverage of ABA and how companies are able to get away with such denials. Frankly, the answer seems to be that insurance companies get away with it because no one in this state has told them they can’t! Does that sound overly simple? Well, a small handful of states have passed legislation requiring their insurance companies to cover ABA services. Such legislative acts are called “insurance mandates,” and South Carolina already has a number of them on the books (mandating coverage for services such as mammograms, pap smears, diabetes treatments, cleft palates, etc.)

I have written an insurance bill to cover autism treatments, and it is being introduced in the South Carolina House of Representatives and Senate during the upcoming legislative term. Along with another mom, Lisa Rollins of Saluda, and my research assistant from the law school, Alex Sparra, I have met with Rep. Nathan Ballentine of Columbia, who is going to be the primary sponsor in the House, and Sen. Ray Cleary of Murrell’s Inlet, who is going to be primary sponsor in the Senate. Both legislators are very enthusiastic about helping us pass this bill, but they’ve let us know that it will be a lot of work. Obviously, the insurance companies will oppose this legislation, and they have lots of money and powerful lobbyists. We don’t. However, we can be passionate, powerful advocates for our children, and legislators would much rather hear from us than from lobbyists who are paid to advocate their position. Each and every one of us has time constraints beyond those faced by most parents, but we can pass this legislation if we all chip in a little bit of time.

Here’s where I need your help. We need to make personal contact with every single state legislator in South Carolina and directly ask him or her to co-sponsor this bill. We need to personally explain what autism is, what ABA is, and what it costs families. Do you know a legislator? Would you be willing to visit or call your legislator? You’d be amazed how easy it is to set up a short appointment with your legislator. Just call the office and ask for 15 minutes. That’s all it takes. If you need to find out who your legislator is or how to contact him or her, go to
http://www.scstatehouse.net/ and enter your zip code. If you will set up an appointment, I’ll go with you to meet with your legislator.

Attached is a copy of the proposed insurance law. You’ll note that, to help prevent fraudulent claims and thus help ensure passage of the bill, an autism treatment needs to be prescribed by a doctor before the insurance company is required to cover it. Your developmental pediatrician can prescribe ABA and other necessary treatments.

Please e-mail or call me at the above numbers to let me know if you will help in this effort. I am looking for at least one family in every South Carolina legislative district to take the lead.

Thanks for your consideration of this matter, and I look forward to hearing from you soon.


Sincerely,

Lorri Unumb

P.S. The South Carolina Autism Society and the Children’s Law Committee of the South Carolina Bar officially support this bill.

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