University  Of Colorado Denver Expert Supports Autism Ruling

Autism Impacts Approximately 1.5 Million People in America Today

Early Childhood Intervention and Support for Children with Autism Can Save Billions of Dollars in Long-Term Health Care Costs

DENVER (NOV. 30, 2007) - Jill and Stephen Tappert and their family won a hard-fought health insurance arbitration last week requiring Anthem Blue Cross and Blue Shield to cover more than $110,000 of prior charges for behavioral therapy for their four-year-old child with autism. A University of Colorado Denver professor says autism is finally getting the attention it deserves as a condition that warrants timely medical treatment.

The Tapperts filed for formal arbitration one year ago on behalf of their daughter, Abby, after more than one year of appeals, countless phone calls, and numerous letters with reams of attachments had not yielded results. "I hope other families are encouraged to continue this advocacy," said Jill Tappert. "That's what this arbitration was about - advocating for my child and her peers to get treatment critical for them to lead as healthy and happy lives as possible."

As recently as a decade ago, autism was considered a low incidence disability. This is no longer the case.
Now autism:

• Accounts for 1 in 150 births
• Affects approximately 1.5 million people today
• Is the fastest growing developmental disability
• Has an annual growth rate of 10-17 percent
• Costs $60-90 billion annually, 90 percent of those costs are for adult services
• Costs of treatment can be reduced by 2/3 with early diagnosis and intervention over the lifetime of an individual
• In 10 years, the annual cost will be $300-400 billion.

"This decision to recognize early and intensive behavioral treatment as a medical necessity for young children with autism is not only a watershed event in and of itself, but it is also a part of a growing national movement that provides all those affected by autism with real hopes of receiving evidence-based services in a timely manner," said Phil Strain, Ph.D., Professor of Educational Psychology and Psychiatry at the University of Colorado Denver School of Education and Human Development." Dr. Phil Strain has been studying autism in depth for 25 years and was the Tapperts' Expert Witness in the trial. Dr. Strain's model of early, intensive services for autism is one of only eight models recognized by the National Academy of Sciences. The National Autism Center has designated his specific research on treating the social skills deficits of children with autism as one of the 10 most influential discoveries in the field.

Early, intensive services for autism can cost as much as $60,000 per year; but results demonstrate that these services can take a child from requiring life-long intensive support and dependence toward a path of independence in as little as two years of therapy. Some of the findings in the decision include:

• Applied Behavior Analysis (ABA) is not "experimental" and, in fact, "is the standard of care in treating autism"
• Autism is a "congenital defect" and/or "birth abnormality" and, therefore, is not subject to certain policy exclusions
• ABA is within two coverage provisions of the PPO policy
• ABA is medically necessary to prevent the self-injurious and aggressive behavior that this child demonstrated

Betty Lehman, executive director of the Autism Society of Colorado, said that while the decision was based primarily on the facts of this particular case, this case can serve as somewhat of a "blueprint" for other families to follow in advocating for their own children. "Legal rulings are used as precedent all the time," Tappert said. "This ruling gives others one more arrow in their quiver. We need everyone to understand that treating individuals with autism helps both the individual personally and everyone else," That's what many insurance companies and legislators seem to be missing - that people who receive effective treatment are more productive members of society and are more likely to live independently."

The University of Colorado Denver is one of three universities in the University of Colorado system. Located in Denver on the Downtown Campus and at Ninth & Colorado Blvd., and on the Anschutz Medical Campus in Aurora, Colo., University of Colorado Denver is Colorado's premier research university offering more than 100 degrees and programs in 12 schools and colleges and serving more than 28,000 students in Metro Denver and online. For more information, visit the website at www.uchsc.edu or the UC Denver Newsroom at www.uchsc.edu/news.