A Tucson doctor is taking his employer to court because his medical insurance won’t cover a commonly prescribed autism treatment for his 5-year-old son.
Dr. Micah Etter, a neurology resident at Banner-University Medical Center, and his wife, Laura Etter, are lead plaintiffs in a class-action lawsuit recently filed against Banner Health, Arizona’s largest private employer.
The couple says they’ve had to borrow money from loved ones to continue the therapy that has helped their son learn to talk and to control harmful tendencies such as biting and banging his head against the floor.
Autism is a brain disorder that affects an estimated one in 68 children. They often have difficulties with communication and social interactions and may have obsessive interests and repetitive behaviors that interfere with daily life.
The treatment the Etters are fighting for, known as applied behavioral analysis therapy, was covered until recently by the health insurance Micah Etter had as a medical student at the University of Arizona.
That changed once he started work at Banner-UMC, the local hospital affiliated with the university, just after graduation last year.
“We were excited because we thought we’d have good insurance” through the hospital, recalled Laura Etter.
When told their son’s therapy wouldn’t be covered, “It seemed like it must have been a mistake,” Micah Etter added.
The treatment isn’t cheap. Therapists typically charge around $100 an hour and can spend 20 hours a week or more working with an autistic child.
Doctors prescribed 30 hours a week of treatment for the Etters’ son. That works out to about $150,000 a year without insurance, “which is way more than we can afford,” Laura Etter said.
Major health insurance plans sold in Arizona are required by law to cover the treatment. But the law doesn’t apply to Banner because its health plan is self-funded and only for its employees.
The lawsuit claims Banner is violating a 2008 federal law that requires insurers to offer equivalent coverage for both physical and mental-health conditions.
Banner has yet to respond to the lawsuit, which was filed in Phoenix on the Etters’ behalf by the Arizona Center for Law in the Public Interest.
In an email to the family, Banner benefits director Jami Allred said the therapy they are seeking is costly and isn’t covered because it “is still considered experimental.”
That claim is at odds with the views of the U.S Centers for Disease Control and Prevention, which says the treatment is “widely accepted among health care professionals and used in many schools and clinics.”
Banner spokeswoman Jennifer Ruble said the firm’s insurance plan does provide coverage for other autism-related treatments such as prescription medication, speech therapy, physical therapy and occupational therapy.
The Etters say they opted for a class-action suit because they suspect other families are having similar struggles in the six states in which Banner operates medical facilities.
“With one in 68 children affected, we can’t be the only ones,” said Laura Etter.
“We’re not just doing this for us. We really hope this case will help them, too.”