Gov. Cuomo, make insurance coverage trade pay its justifiable share

If there was such a thing as a matter of course for the governor it would surely be an obligation to provide insurance coverage and more clinical help for very young children with disabilities.

These services are anchored in the state’s early intervention program, which began in the 1990s to support young children from birth to three years of age. Like programs for pre-K, special schools, and public schools, such services are free to parents whose children have been diagnosed with a disability. It is paid for by commercial insurance or Medicaid for the families with insurance coverage. In the case of uninsured families, the state and rural districts share the costs and reimburse the service providers.

Sounds like an ideal construct. Children receive help correcting their problems as toddlers, saving the state and local governments hundreds of millions of dollars in avoided and more complex costs later. And 70,000 parents don’t have to worry about how to get and pay for the help their children need. What could go wrong?

Join the lobbyists of the private insurance companies. Their job is to protect their clients from paying their fair share of the cost of early intervention for the families they insure.

These companies have shirked their responsibility since the early intervention program was introduced. They are very good at collecting their premiums, but not so good at paying for the necessary services billed to them. Sound familiar?

They find creative ways to turn down almost 85 percent of these claims year after year. The 15 percent they pay contrasts with the 70 percent that state insurance pays in the form of Medicaid.

The result, according to statistics from the State Department of Health and its Bureau of Early Intervention, is that of the $ 700 million annual cost, insurance pays only about $ 13 million, a tiny 2 percent. Whatever property insurance refuses, the state and counties pay the tens of millions of dollars in additional costs each year. Ultimately, New York taxpayers pay the bill.

That year, lawmakers said “enough” and passed a bill requiring commercial insurance to cover early intervention costs, as was always intended. The measure stipulates that the insurance company will reimburse around 50 percent of the costs invoiced to them.

Insisting that the insurance industry finally pay their fair share would allow providers to avoid the futile but costly and time-consuming efforts to withdraw payments from these recalcitrant companies and allow them to rely on clinical help for children at risk focus while saving the state and local governments millions of dollars each year.

Child’s play, isn’t it? No, not if you insult the deep-seated insurance industry.

This sensible and necessary legislation is now awaiting Governor Andrew Cuomo’s decision to approve or veto the bill. Insurance industry lobbyists can be counted on to vigorously oppose this reform and use all of their resources to convince the governor that the state and counties should continue to subsidize them as they refuse to pay for legitimate claims.

How will this end? Sad to say, but sometimes the governor’s desk is the place where good public policy ideas die to serve the particular interests of well-heeled industries.

Steven Sanders from Troy is the executive director of Child Therapy Services Agencies. He was an MP for 28 years.

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