Some good news. Mary Ann Roser reports on the investigations by major health insurers that are creating funding difficulties for autism clinics which specialised in unproven and dubious treatments for autism:
The owner of an Austin-area clinic that treats children with autism — using techniques that are controversial in mainstream medicine — says investigations by three major insurers have left it with a pile of unpaid claims and a crisis: She’s had to lay off most of her staff and drastically reduce the clinic’s hours.
In addition, Kazuko Grace Curtin said the Texas Medical Board is investigating her medical director. She and the doctor — Jesus Caquias — say the investigation is a way of harassing them because they offer nontraditional care for autism patients.
[…]
CARE Clinics is struggling now because Aetna stopped paying claims in August and is questioning “about $1 million” in claims, Curtin said. Cigna and United Healthcare stopped payments in October and are disputing smaller amounts that Curtin declined to reveal. United is paying again but at a lower rate, she said.“What they were saying is, autism treatment is not established, it’s experimental,” Curtin said.
Spokeswomen for Cigna and United said the reviews were routine to ensure proper payments. Aetna declined to comment.
Curtin said she closed the two clinics in January to cope with the amount of paperwork she had to produce when the three insurance companies challenged charges for all patients treated in October, November and December. She reopened the Austin clinic March 6, but now it’s open 10 days a month instead of 20 and has 10 employees instead of 40, she said. The Tampa clinic won’t reopen until May, she said.
She also is delaying indefinitely a 30,000-square-foot medical building, school, corporate offices, sports facility, lodge and conference center in Dripping Springs.
“I need some funds,” Curtin said, declining to release specific financial details about her business. “I don’t know how long we can survive.”
The bad news is that while CARE Clinics extract money from increasing skeptical insurers, Thoughtful House is careful to extract the money directly from vunerable parents. Read the whole article for the other non-finanicial pressures on such clinics, and the pleas of victimisation from their owners.
Left Brain Right Brain 
These folks want it both ways: they don’t want to go through the long, expensive and difficult process of actually proving these treatments work, yet they want insurers to pay.
My insurance pays for evaluations, but doesn’t pay for any therapy–including ABA or occupational therapy–associated with an autism diagnosis.
the quackwatch page mentioned in the article is here:
http://www.autism-watch.org/reports/casd/overview.shtml
It strikes me that the woman running that clinic may not be entirely honest about why the insurance companies are reviewing payment. According to the quackwatch site:
“The current minimum charge for people who do not have insurance appears to be $8,500 for the CARE BioMarkers evaluation plus $500 for a “first-time patient fee.” In cases I have investigated, however, the insurance company was billed more than $40,000 per person.”
$8,500 for intake?!? $40,000+ per person? Those charges seem extreme to this reader.
Our insurance covers OT for autism as long as there is a clear secondary diagnosis to support it; ie dyspraxia, dysgraphia, etc. So if there is a specific problem that is considered medical (not educational), then the medical insurance covers it. Speech works the same way; he’s not technically in speech therapy for autism per se, but for the resulting apraxia and muscle tone issues.
I’m glad folks are taking a hard look at some of these places and what they are charging (even before they look into what they are charging for.)
Does Texas have mandatory insurance coverage of Autism?
Texas Department of Insurance and Rick Perry is controlled by the insurance companies. They will never stand up to Aetna, and they want kids institutionalized so taxpayers will have to cover autism. Texas has some of the most terrible conditions in the country for kids that get put in institutions. The Department of Justice threatened in 2008 that if conditions didn’t improve they were going to sue the state of Texas. Rick no charisma Perry’s dream of being in the white house is ridiculous.
The only reason Thoughtful House is not in trouble is because they don’t bill insurance. They do all the same treatments, and tests as Care Clinics. They give out HCFA’s just like Dr. Rea did before he was attacked. Aetna would rather spend 1,000,000 dollars to treat a 90 year old man who has smoked his whole life for lung cancer than help a 3 year old child who has developed autism and has lost all communication and contact with the outside world. Shame on you Aetna. Aetna has their own private army of federal agents in Texas who they use to harass any clinics they don’t want to pay. Rick Perry shame on you. Government Healthcare is much better than Aetna mafia care. If you have a child with autism you should boycott Aetna. Stand up for health freedom now!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
@Jacob Marley: do you have insurance? I assume you are upset because most insurances do not cover treatments that are experimental or not science-based medicine. If you want to treat an autistic child with quack therapies, then you should pay them out of pocket. Don’t raise MY premiums with your fraudulent treatments. My nieces get PT, OT, Speech Therapy and other proven treatments which ARE covered by insurance, but their parents struggle NOW to pay the premiums. They don’t need to pay exhorbitantly high premiums to cover your desired quackery-of-the-week.
And why do you think Thoughtful House and the like rarely accept insurance? Because insurance tries to pay for Medically Necessary treatments that have been found effective in peer reviewed literature, not quackery that is written up by the Geiers or Andy Wakefield.