Insurers in Calif. Facing Autism Treatment Denial Lawsuits

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As the need for autism treatment coverage continues to rise in California, an increasing number of claim denial lawsuits have been filed against insurance companies. Each of these lawsuits allege that the company denied their claim for treatment coverage, without adequate information or facts when making the decision.

Traditionally, California families with autistic children have relied on the public school systems and regional centers to provide care and therapy for their children’s development. Like many states, California funding for autism treatment has taken severe cuts over the years. Vital therapies such as applied behavioral analysis (ABA), occupational therapy, physical therapy, and speech therapy services have all been reduced in the schools.

This has caused many parents to file claims with their insurance companies, in an attempt to provide the necessary care for their children. But many insurance companies have turned down these claims, so to respond to the growing need of these families, California has mandated insurance companies pay for children’s autism therapies.

Californian autism treatments are currently regulated under Assembly Bill 88/Mental Health Parity Law (AB88), which requires that individuals with severe mental illnesses must receive the same therapies as those with any other medical condition. For example, if an insurance company provides a stroke victim with speech or physical therapy, they must provide that same service to a person with autism, if proven to be medically necessary.

However, AB88 does not require coverage for all medically necessary treatments recommended by medical experts for autism coverage. Due to this loophole, insurance companies have been able to deny autism treatment claims, by arguing that some of these therapies are educational or are used to treat learning disabilities, and are not for medical purposes.

Overview of Autistic Treatment Coverage

Florida State University Professor Jon Bailey told those at a national autism conference about a flawed journal article he said had been used to discredit successful treatment for behaviors related to autism. He explained that the article characterized the treatments as “experimental,” which presented a loophole for insurance companies to deny coverage. He reminded the conference attendees of the need for autistic therapy treatments, such as ABA, and how many of them had been proven to produce results. Bailey and other experts have encouraged families who were denied insurance coverage for their treatments to seek legal help for a potential lawsuit.

California insurance companies are regulated by the California Department of Insurance (DOI) and Health Maintenance Organizations (HMOs) are regulated by the California Department of Managed Health Care (DMHC). Legal experts advise potential plaintiffs to be educated about their child’s condition, what their potential complaint pertains to, and to file all necessary medical documents on the appropriate dates.

Many of the autism treatment lawsuits filed against California insurance companies allege that the companies denied them based on bad faith insurance practices, and uniformed and biased assessments.

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.