2006-09-01 / Community

Pheffer Lauds Autism Insurance Law

Assemblywoman Audrey I. Pheffer has announced that, after intense negotiations, New York State has enacted legislation pertaining to insurance coverage for autism spectrum disorder.

"Autism is one of the fastest growing disorders in the United States. It is important that we not only raise awareness of these conditions, but also ensure that children are receiving the diagnoses and treatments necessary for their health and well-being," said Pheffer.

The new statute, Chapter 557 of the laws of 2006, amends the insurance law by adding a provision that states that every policy which provides coverage for hospital, surgical, or medical care shall not exclude coverage for diagnosis and treatment of medical conditions otherwise covered by the policy solely because the treatment is provided to diagnose or treat autism spectrum disorder. The statute also defines autism spectrum disorder as a neurobiological condition that includes autism, Asperger syndrome, Rett's syndrome, or pervasive developmental disorder.

"This new law is a vital first step in promoting awareness and treatment for these disorders. I will continue to work with my colleagues to examine not only insurance coverage issues but also to look at the programs provided for treatment and find methods to possibly improve access to and content of these programs statewide," said Pheffer.

Autism is a complex neurobiological disorder that severely affects the way autistic individuals relate to others socially and their ability to communicate and learn. Although it is considered a life span disorder of varying severity, autism is treatable. Early diagnosis and intense early intervention have been proven to provide the same benefits to individuals with autism that medication or medical procedures provide to individuals afflicted with other similar physical or bioneurological disorders. However, many children with autism are not properly diagnosed until years after the first symptoms appear. Furthermore, although insurance companies and health maintenance organizations routinely cover treatment for similar neurobiological disorders, many health insurance plans in the state of New York have denied coverage for diagnosis and treatment based solely on a diagnosis of autism.

The CDC has called autism spectrum disorders a significant public health concern and urged intervention as early as possible to enable all affected children to reach their full potential.

The new statute will become effective January 1, 2007. If a New York policyholder believes their insurer is wrongfully denying health coverage, they can file electronically a formal complaint with the New York State Insurance Department by logging onto its website, http://www.ins.state.ny.us, and click on the 'Consumers' icon. The Department also maintains an Insurance Help hotline at 1-866- NYINSHELP (1-866-694-6743).

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