ATPIAN Foresees and Resolves Lack of In-Network Autism Treatment Providers Conundrum

Online, July 16, 2011 (Newswire.com) - The California Senate Select Committee on Autism and Related Disorders met on July 13th to discuss the controversial issue of health insurance coverage for the treatment of Autism in California. The hearing quickly veered away from a narrow discussion on insurance coverage for autism treatments to a more comprehensive look at the drastic lack of access to network autism treatment providers. Testimony was heard that insurance companies operating in California have minimal - if any - contractual agreements with "in-network" autism treatment providers. Additional testimony revealed that the restrictive licensing and supervision requirements under consideration would further limit access to experienced autism treatment providers.

Senator Darrell Steinberg (D-Sacramento), President pro Tempore of the California State Senate and Chair of the Senate Select Committee on Autism and Related Disorders, closed the more than three hour session by saying "We are in fact making some progress... We cannot unduly restrict access by unreasonably limiting who can provide services". Steinberg's concluding words came after testimony by parents, advocates and representatives of the Applied Behavior Analysis (ABA) provider community stressing that even if insurance companies agreed to cover autism treatments, they do not have a pool of providers to whom their insured members can be referred. In fact, families seeking treatment are often sent on their own "service provider search missions" only later to have their claims denied due to the providers being "out of network". A vicious circle!

Jim Lantry, a veteran advocate for the needs of the developmentally disabled, with more than a decade of professional expertise focused on the interests of families coping with autism and those serving them, and a former insurance executive, anticipated this conundrum. He established ATPIAN - Autism Treatment Providers' Insurance Authorization Network - as a way to break the cycle. ATPIAN assists individual applied behavior analysts and practices with multiple behavior intervention practitioners through the process of becoming authorized, credentialed, "in-network" providers with insurance companies.

"Autism insurance reform is sweeping the nation. It's not a question of 'if' but rather a question of 'when' legislation will pass requiring that insurance companies cover autism treatment. It seemed clear to me that, just like with any other specialty, the insurance companies would need to build up a pool of autism treatment providers for their members," explains Lantry. "And since insurance has generally not covered this type of care before, the providers simply have no idea how to go about getting that done. What ATPIAN offers is a win-win-win: the insurance companies establish the required contractual relationships with providers; the autism treatment providers are able to offer "in-network" care to their clients; and the families are able to gain access to the autism treatments their loved ones need from network providers so they don't have to pay out of pocket."

"Being a contracted 'network' provider is going to be a must for autism treatment providers just like it already is for pediatricians and cardiologists. It's not rocket science, but the process is formidable, it's labor intensive and it takes time. My recommendation is that now is the time for autism treatment providers to get the ball rolling," Lantry concludes.