A federal appeals court last week has given the green light to families denied certain autism therapy coverage to press forward with a class action lawsuit against Blue Cross Blue Shield of Michigan.
The Sixth Circuit Court of Appeals denied a petition by Blue Cross Blue Shield of Michigan that would have overturned an earlier ruling that gave clearance to parents to sue the insurer for denying Applied Behavior Analysis therapy for autism, on the ground that the therapy was “experimental.”
The rejection of Blue Cross Blue Shield’s petition means that the case can proceed on behalf of all families who were denied ABA therapy by Blue Cross, even those who never submitted a claim to Blue Cross in light of Blue Cross’ well-known policy of denying claims for the autism treatment.
The case, Potter v. Blue Cross Blue Shield of Michigan, is the second such class action lawsuit against the organization in three years. A previous class action lawsuit, Johns v. Blue Cross, resulted in a 2010 class action settlement that provided ABA therapy coverage to almost 100 Michigan families that were previously denied the treatment.
Despite the class action settlement, however, Blue Cross continues to deny claims for ABA therapy to children with autism spectrum disorder on the grounds that it is an unproven form of treatment, which led to the filing of the Potter case.
Blue Cross continues to dismiss ABA therapy as “experimental,” despite prestigious organizations, such as the National Institutes of Mental Health, the Centers for Medicare & Medicaid Services and the American Academy of Pediatrics, recommending the treatment as an effective form of autism therapy.
The U.S. Surgeon General has also recommended ABA therapy, stating that “30 years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and increasing communication, learning and appropriate social behavior.”
The case is Potter v. Blue Cross Blue Shield of Michigan, Case No. 10-cv-14981, Eastern District of Michigan, Detroit.
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2 thoughts onBlue Cross Autism Treatment Class Action Moves Forward
Please get in touch with me. We were denied by BCBS texas in 2013 after my son’s diagnosis. He went over 9 months without ABA therapy that was prescribed by two doctors. I had to file a complaint with the state of texas after BCBS denied coverage for said therapy AND denied my appeal. They finally agreed to cover it 9 months later but the loss of CRITICAL therapy needed when my son was still under age 3 can never be made up.