Health Law

Insurance Co. Agrees to Settle Key Autism Case With 100 Families

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As lawmakers across the country draft and pass legislation that requires insurance companies to pay for autism treatments, a Michigan insurance company has opted to settle with 100 families seeking to be reimbursed for autism treatments for their children.

The $1 million class action settlement agreed to by Blue Cross Blue Shield of Michigan last week, is being praised by autism advocates who are hopeful it means the end of claim denials from insurance companies that say behavior therapy for autistic children is experimental, the National Law Journal reports.

Gerard Mantese, who represents the lead plaintiff in the case, told the Detroit News that the settlement moves the issue nationally.

“This is a landmark settlement. The result here in Michigan is going to make it more and more difficult for insurance companies in other states to try to cut costs by denying critical care to children who really need it,” he said.

So far, 13 states have laws requiring insurers to reimburse families for behavior therapy, including recent additions: Connecticut, Colorado and Nevada. The NLJ notes that New Jersey is mulling legislation and Pennsylvania’s law goes into effect July 1.

The case, Johns v. Blue Cross Blue Shield of Michigan, was filed in the Eastern District of Michigan and challenged the insurer’s practices of denying claims for a well-known treatment, applied behavioral analysis, which attempts to change behavior through positive and negative reinforcements.

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