Autism Insurance Denials Leading to Lawsuits

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California is among 37 states that require health insurance plans to provide comprehensive autism treatment coverage. Despite state laws that require this comprehensive coverage, many insurance companies have allegedly made a practice of denying autism health coverage, especially services like Applied Behavioral Analysis (ABA), speech therapy, and occupational therapy.

Many families with children diagnosed with autism have filed autism insurance lawsuits (also known as autism coverage lawsuits) to gain the coverage their children are entitled to, or, in some cases, regain autism treatments lost due to later denial by health plan providers.

In Washington state and federal courts, multiple families filed a consolidated autism insurance class action lawsuit against Premera Blue Cross, one of the largest insurance companies operating in the Pacific Northwest, for allegedly violating the Washington State Mental Health Parity Act.

According to the autism class action lawsuit, Premera instituted developmental disability exclusions which denied patients with autism access to, or severely limited their access to, neurodevelopmental therapies that are considered standard and helpful treatments for autism. Premera settled the class action lawsuit for $3.5 million and changed its insurance policies to provide full autism treatment coverage.

While other states are still in the process of establishing laws to protect individuals with autism from bearing the burden of the cost for autism treatment, other states like California have autism parity laws in place and have included autism in the state’s benchmark health plan.

California Insurance Commissioner Dave Jones has been working on clarifying insurance companies’ obligations under the 2011 California autism parity law so that patients can receive necessary autism treatments. According to the autism parity law, insurers in California will require insurance companies to cover ABA therapies without requiring cognitive testing beforehand and without setting annual spending limits.

California Insurance Laws regarding Autism Insurance Coverage

The autism parity law, known as SB 946, was proposed in 2011 and signed into California law later that year. SB 946 states:

“This bill, effective July 1, 2012, would require those health care service plan contracts and health insurance policies, except as specified, to provide coverage for behavioral health treatment, as defined, for pervasive developmental disorder or autism.”

Because of this law and other provisions made under this law, California insurance companies cannot deny autism treatments, including ABA, speech therapy, and occupational therapy. The California autism parity law also prohibits insurers from setting a number of visits permitted to patients and denying to cover visits after they exceed that set number.

It also illegal in California for insurance companies to deny or delay autism treatment for behavioral issues based solely on the basis that cognitive testing is needed before treatment can be administered. Many families with children with autism have been illegally denied ABA and other autism treatments by their insurance companies and may be eligible to pursue an autism treatment lawsuit or join autism insurance class action lawsuits.

Join a Free Autism Treatment Insurance Denial Class Action Lawsuit Investigation

If a California insurance company refused to cover or suddenly stopped covering your child’s autism treatment, you may have a legal claim. Find out if you qualify to join a free class action lawsuit investigation against insurers like Anthem Blue Cross, Blue Shield, and Wellpoint. Obtain a free case evaluation now.