Anthem Reaches Autism Therapy Coverage Class Action Settlement

Anthem has agreed to settle a class action lawsuit challenging the company’s refusal to cover autism therapy.

In 2016, two Indiana families sued Anthem claiming that the company stopped covering autism therapy treatment for their children.

This week, Anthem has agreed to change its guidelines for coverage, and they state that they will no longer base their coverage only on a patient’s age.

Additionally, the company has agreed to provide monetary compensation to Indiana policy-holders with children over the age of seven who have an autism diagnosis and were denied coverage by the company.

The two families, Chester and Kathryn Pierce of Elkart County and Michael Beck and Joanne Kehoe of Indianapolis, claim that their children were receiving 40 hours a week of autism therapy that was covered by Anthem. The families claim that in 2013, Anthem reduced the number of hours of therapy that would be covered by insurance.

According to both families, the reduction in coverage occurred over a period of time, when the company reduced coverage by 10 hours, then by another five over 2013. The families claim that when they questioned the company about this change in coverage, the company stated that the therapy could be obtained through their children’s school system.

The two families say that the reduction in therapy coverage by Anthem had a dramatic impact on their children’s well-being. Allegedly, the two children saw an improvement in social skills, toilet training, and communication abilities when they were receiving 40 hours of therapy per week thanks to Anthem coverage. Without the 40 hours of therapy, their parents state that they saw a dramatic regression in their children’s skills in these areas.

Previously, Anthem had set an age cut-off for autism therapy coverage — allegedly, the company claimed that they would not cover 40 hours a week of behavioral therapy for children over seven years old. If this settlement is approved by Indiana court, the company will no longer use age as their primary determinant of whether or not a child will be covered.

Additionally, if this settlement is approved by the court, the company will pay monetary compensation to affected Indiana beneficiaries. According to the settlement, Anthem will compensate policyholders who had children over the age of seven who had an autism diagnosis and received coverage for autism therapy, then were denied coverage in part or entirely between April 2012 and Dec. 31, 2017.

According to the Anthem autism coverage class action lawsuit, around 200 children and their families will receive compensation for therapy that should have been covered under their Anthem health insurance policies. 

The settlement received preliminary approval by Indiana courts on March 28, and is awaiting final approval.

Top Class Actions will post updates to this class action settlement as they become available. For the latest updates, keep checking TopClassActions.com or sign up for our free newsletter. You can also receive notifications when this article is updated by using your free Top Class Actions account and clicking the “Follow Article” button at the top of the post.

The families are represented by Toby J. Marshall of Terrell Marshall Law Group PLLC.

The Anthem Autism Therapy Coverage Class Action Lawsuit is Kathryn Pierce, et al. v. Anthem Insurance Companies Inc., Case No. 1:15-cv-00562-TWP-TAB, in the U.S. District Court for the Southern District of Indiana.