Debate over autism coverage continues as mom sues providers for discrimination

Categories: Health Care, Law
courtesy Tracy Reid
Tracy Reid is suing insurance companies and the state for not covering therapy that helped cure her autistic son Max, 7, of his most severe symptoms.
Tracy Reid's seven-year-old son, Max, was diagnosed as severely autistic in 2008. Over the next two years, he experienced huge gains through a type of treatment known as Intensive Early Intervention Behavioral Therapy, or IEIBT. Advocates say it's the closest thing to a cure for autistic children, and 31 states require insurance companies to cover it.

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But, despite legislative efforts, Minnesota's not one of them. When Reid's old provider, Health Partners, balked at the therapy's hefty price tag, Reid, a systems-savvy lawyer, quickly switched her son's coverage in order to keep him in treatment.

Once Max's prognosis improved though, "Suddenly I had the space to be angry again," Reid said in our January 2011 cover story on the subject. "I was thinking of all these other people. That's when I knew I was going to sue them."

Now, two years later, Reid's making good on her word. On November 30, she filed suit against HealthPartners, Blue Cross Blue Shield, and the Minnesota Department of Commerce for discriminating against her son.

When Max was first diagnosed autistic, he hated physical contact, was prone to violent tantrums and getting kicked out of daycares, and had an I.Q. in the first (lowest) percentile. Reid, a single mother, feared that as he got bigger she wouldn't be able to care for him.

Reid details one particularly harrowing pre-IEIBT incident in her recent complaint. She was with Max at Choo Choo Bob's Train Store, and after playing with Thomas the Tank Engine, picked Max up to leave. Max head-butted her so hard that she dropped him.

Her head was ringing and her vision was blurry, and Reid worried both she and Max might be concussed or injured. She didn't seek treatment, however, out of concern that a hospital would "cite her as unable to meet Max's special needs."

Days later, Reid began seeking more help, and by the end of the summer, enrolled Max in up to 40 hours per week of IEIBT.

Some studies show that nearly half of autistic children treated with the method emerge with "best outcomes." In other words, a diagnosis that takes them off the autism spectrum, and into "normal" ranges, entirely.

Max was one of them. After about a year in IEIBT, his mental tests, I.Q. included, all registered in a normal range. As Reid's complaint describes, Max has friends, shares his toys, loves reading (particularly Captain Underpants books), "tells jokes which generally make no sense and is a very happy and funny kid." His violent episodes, which peaked at 20 per hour, are now closer to zero per week.

But as our cover story detailed, Reid's insurance, HealthPartners, wouldn't cover the treatment. Costs for IEIBT can run up to $100,000 per year for the first few year's of a child's life.

Advocates say that stacked against the expenses of life without treatment, IEIBT is a deal. As Nick Pinto reported, "When you factor in the cost of 18 years of special education and a lifetime of care-giving, the heavy investment in a few years of IEIBT looks like a relative bargain." (One study calculated that "Texas would save $2.90 billion by treating its autistic children with IEIBT.")

(For more, click to page two.)

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