Blue Cross and Blue Shield of Illinois blinked after healthcare providers and parents of autistic children complained about proposed cuts in reimbursement rates for coverage of in-home counseling.
Blue Cross late last year said it would trim rates by an aggregate 26 percent for commercial members. After the outcry, those reductions, effective this month, were scaled back to 14 percent, it said.
Parents and providers launched a website, Get Through to Blue, to pursue their goal. They were worried about the influence of Blue Cross' then-pending action on other insurance companies' decisions.
"I do think the effort was successful—we have more to do," says Stephanie Gorbold, a behavior analyst and president of her industry association's Illinois chapter. Compared with Blue Cross' initial intention, which she said could have been devastating, "progress is being made. I've got to stay positive about that."
Colleen Miller, a Blue Cross spokeswoman, described the talks with providers as routine and said lower rates were designed "to bring us in line with industry standards."
She adds, "There were always conversations going on. Our teams listened, and that's what resulted in the rate adjustment. The benefits and provider networks they had access to were not changing and didn't change."
In April, the Centers for Disease Control and Prevention said the number of children diagnosed with autism spectrum disorders by age eight rose again through 2014—to one in 59, almost double the ratio a decade earlier.
Access to records, which varies widely among 11 reporting sites, could influence the figures, however.
Coverage of autism therapy for school-age children has stirred controversy. In Indiana two years ago an Elkhart couple sued the state's largest insurer, Anthem Blue Cross and Blue Shield, over denial of coverage for their son's treatment during school hours.
The lawsuit, which sought class-action status, was settled earlier this year, according to Anthem spokesman Tony Felts. He didn't follow through on a promise to provide details.
In Illinois, an insurance mandate has covered diagnosis and treatment of autism spectrum disorders for people under 21 since 2008.
The Get Through to Blue campaign urged sympathizers to send the multi-hued autism-awareness ribbons to Blue Cross leaders—but only after removing the color blue.
Miller said Blue Cross received "multiple boxes" of ribbons.
Gorbold said another "big change" is on the way that will affect the Blue Cross relationship with providers: revisions in Current Procedural Terminology (CPT) codes, which tell insurers what procedures healthcare providers would like to be reimbursed. They'll be released in August and effective Jan. 1, she said.
"Amid backlash, Blue Cross scales back rate cuts for autism treatment" originally appeared in Crain's Chicago Business.
