Jun 29 2009

Coverage for Autism Treatment

Parties reached a $1 million settlement in an Eastern District of Michigan class action suit against an insurance company regarding coverage for certain behavioral therapy/treatment for autism. The settlement money will reimburse at least 100 families for the costs of past behavioral therapy, in this case, applied behavioral analysis (or ABA therapy), for their autistic children. Coverage was previously denied on the grounds that the therapy was experimental. However, documents obtained during the litigation revealed that ABA treatment is “currently the most thoroughly researched treatment modality for early intervention approaches to autism spectrum disorders and is the standard of care recommended by the American Academy of Pediatrics, National Academy of Sciences Committee and the Association for Science in Autism Treatment, among others.” Going forward, the insurance company will offer insureds the option to purchase coverage for early intervention autism treatment.

Lawyers involved in the litigation believe it may be the first settlement where an insurance company has agreed to provide coverage for such autism treatment and are hopeful that the case will instigate more insurers to follow suit. Moreover, at least 13 states have passed laws requiring insurance companies to pay for autism treatment and screenings, and the news of the settlement may call other state legislatures to action.

You can find a full report on the case in The National Law Journal, which reported the story on June 23.

To read about Wisconsin’s efforts in requiring insurers to cover autism treatment, click here.