Archive for the 'Families' Category

In the US state of Michigan, a major health insurance provider will now reimburse families for the cost of providing therapy for children with autism. The case, Johns v. Blue Cross Blue Shield of Michigan, arose because Blue-Cross-Blue-Shield denied payment for behavioral treatment often called “ABA” to the family of a child with Autism. The case was settled in favor of the family last week.

Represented by Gerard Mantese, Mr. Christopher Johns alleged that the insurer should pay for the therapy for his son under the provisions of the policy. The insurance company refused and Mr. Johns sued. During depositions, Mr. Mantese and others on the Mr. Johns’ legal team learned of a draft memorandum identifying the behavioral therapy as effective and that a representative of the insurer would probably elect the behavioral therapy if that representative had a child with Autism.

Because Mr. Johns’ complaint was part of a class action suit, many other families will also benefit from the settlement. In an independent analysis of the case, Tresa Baldas discussed the implications.

The $1 million class action settlement from Blue Cross Blue Shield of Michigan comes amid a legislative wave in which a growing number of a states are passing laws that require insurance companies to pay for autism treatments and screenings. To date, 13 states have such laws, the most recent being Connecticut, Colorado and Nevada. New Jersey is currently considering an autism bill, and Pennsylvania’s law goes into effect July 1.

The June 17 Michigan settlement, meanwhile, has autism advocates hopeful that insurance companies will stop claiming that behavioral therapy for autistic children is experimental, and start paying for it.

“It is a significant victory for the families, obviously, and it marks a trend, hopefully, that insurance companies will start to look at autism treatment differently,” said Areva Martin, an attorney at Los Angeles-based Martin & Martin who is currently handling about 30 autism cases. She believes the labeling of autism treatments as experimental is “absurd.”

I wonder what this will mean for the California rules that do not expressly exclude behavioral therapies, but set requirements for deciding whether they are reimbursable (see my earlier post on that story).

Link for a quasi-news article about the settlement. Read another of the law firm’s press releases. Here’s link to Ms. Baldas’ analysis of the case.