Blue Shield of California has reached a settlement with the insurance regulators of California. The insurer is now going to include coverage of autism therapy in their health insurance policies. The settlement has closed the “loopholes” that made it difficult for parents of kids with autism to get their treatment covered.
Blue Shield of California Life and Health Insurance has reached a settlement with California insurance regulators. The insurer has now agreed to cover the cost of the treatments that children with autism need. The agreement has closed some of the “loopholes” that were preventing children from getting the treatment that they needed.
Previous to this settlement, California already had a law in effect that mandated that autism therapy treatment be covered by health insurers. In July of this year, a new state law, called the California Mental Health Parity Act, will go into affect. That law also says that insurance coverage cannot be denied for autism therapy treatment.
Unfortunately, previous to this settlement, there were some insurance companies that were using “loopholes” in order to avoid having to cover the treatments for children who have autism.
Anthem Blue Cross, and Blue Shield of California originally had only agreed to cover the initial cost of the applied behavior analysis (ABA) treatment for a child who has autism. The insurers were covering a minimum of six months of ABA treatments for HMO patients. There wasn’t any promise that these insurers would continue to cover the treatment after the first six months have passed.
Also, they wouldn’t cover the treatment unless it had been deemed “medically necessary” by healthcare providers. This meant that the insurers required the ABA treatment to be offered under the supervision of licensed professionals. This sounds like a good thing, until you realize that there is a shortage of licensed professionals in California who could provide ABA therapy.
As a result of the settlement, Blue Shield of California will no longer deny the ABA therapy as a “non-covered service”. The insurer also will no longer challenge whether or not the treatment is “medically necessary”. They also will stop forcing parents to get approval from an independent medical reviewer before a child who has autism can receive treatment for it.
It is worth noting that this settlement between Blue Shield of California and California insurance regulators stems from a dispute that began last year. In July of 2011, California Insurance Commissioner Dave Jones filed an enforcement action against Blue Shield of California because it was not following the laws that required the insurer to cover the cost of autism therapy.
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