Farmington Talcott Plaza 230 Farmington Avenue Farmington, CT 06032 Phone: (860) 674-1824 Fax: (860) 674-1836   Canton/Avon 50 Albany Turnpike Suite 3020 "Canton Gateway Office Park" Canton, CT 06019 Phone: (860) 693-8720 Fax: (860) 693-8913   info@thetalcottcenter.com         2010 Brings Big Changes to Insurance Coverage  2010 has brought many changes and new state mandates that will effect insurance coverage for Autism.  At The Talcott Center for Child Development, our focus is to maximize insurance coverage and to educate parents on the ins and outs of insurance coverage.  In the past, we have testified in front of the state insurance commission in order to advocate for Autism coverage. In the upcoming year, many insurance companies are moving to a managed care system that may jeopardize the hard work and efforts the autism community has put in.  The Talcott Center for Child Development is working hard with several associates to explore these laws in order to maintain quality and consistent coverage for the treatment we provide.  Look to us for all the latest updates and information regarding these topics.      01.25.2010   Insurance 101 Update   As of 01.01.10, SB 301 has taken effect in Connecticut.  Still, questions remain.  Parents and clinicians are looking for clarification as to whether OT, PT and SLP services for Autism are covered by insurance companies under the bill and to what extent.  OT, PT, and SLP services are mentioned quite frequently in the bill however, some insurance companies claim that the bill states that it is limited to covering behavioral health only.   In an effort to clarify some of these issues, we ask that parents and professionals in the Autism community become educated on these topics and form a grass roots effort to get to the bottom of these issues.    We ask that you take a moment, if you haven't already, to read through the bill and it's amendments.  Below are PDF documents of S.B. 301   S.B. 301 2010 S.B. 301   Looking further into the matter...   According to the most recent release from the Federal Government approximately 1out of 110 children receive the diagnosis each year.  Although the severities range greatly, all literature supports early, intensive, and consistent rehabilitation.  The Bill SB 301 was intended to open up the Autism community to much needed therapies.  Among them, Occupational Therapy, Physical Therapy, and Speech Therapy were included.  However, in Connecticut a managed care company, Orthonet, is now managing visits for Aetna, Cigna, and Anthem insurance products.  This external musculoskeletal company is attempting to manage therapy companies that work with children with developmental delays as well.  They are basing their treatment decisions on a musculoskeletal platform, doling out visits in 6-8 clusters with a 45 day time frame.  At this point treatment is terminated if significant functional progress is not met by the Orthonet Utilization review board.    The problem lies in Orthonet’s concept of treatment duration with children with developmental delays.  Clinical evidence supports longer time frames to justify positive functional outcomes, 6-8 month durations are the norm.   The Bill SB 301 sets time frames for utilization and progress reviews to 6 month durations.  The Bill SB 301 sets visit limitations within the 6 month treatment duration, based on treatment progress and medical necessity only.  The Bill SB 301 sets yearly benefit caps to a specific dollar amount based on the child’s age, a plan that makes all the providers more conscientious and vested in the child’s appropriate treatment plan.    We feel Aetna, Cigna, and Anthem are allowing Orthonet to behave irresponsibly, ignoring the intentions of SB 301 and interpreting the language to best support their business plan by limiting treatment, while children of need continue to suffer.    Our plan and what you can do...   For starters, we all need to become more educated in these matters and become pro-active.  We ask that you contact your insurer and ask the tough questions.  We ask that you call and write to the politicians that put this bill into law and seek clarification.   Feel free to use the letter template below.  Modify it or add to it if you would like to personalize it.  Use the search tools below to find politicians in your district to send letters to.  Also, mail or call the contacts listed on the right.   Every voice makes a difference.  Help us to find answers and get the Autism coverage families in Connecticut need.   Letter Template     Governor M. Jodi Rell, Office of the Connecticut Governor State Capitol 210 Capitol Avenue Hartford, CT 06106   State Attorney General Richard Bloomenthal, Office of the Connecticut Attorney General 55 Elm Street Hartford, Connecticut 06106   Insurance Commissioner Thomas R. Sullivan, P.O. Box 816 Hartford, Ct 06142-0816     Links to find representatives in your area:   http://www.cga.ct.gov/asp/menu/CGAFindLeg.asp  - Rep, Senator and Congressman   https://writerep.house.gov/writerep/welcome.shtml  - US house   http://www.senate.gov/general/contact_information/senators_cfm.cfm?State=CT  US Senate