Several class-action lawsuits have been filed in an effort to require private health insurance companies to cover treatment for autism. The parents want it covered like other conditions that affect the brain are. The insurance companies have been placing caps on the amount of treatment that kids with autism can have covered,
Autism spectrum disorders affect one out of every 88 children. There is no cure, but there are some treatments that can be helpful. Applied Behavior Analysis, or ABA, is a treatment that has been successful. This is not the type of treatment that can be administered once or twice and then ended. It is ongoing.
When insurance companies decide not to cover ABA treatment, it means that the parents have to come up with the money to pay for it out of their own pockets. For many, the financial cost is too high and the much needed therapy ends.
There is more than one class-action lawsuit right now that is about this issue. Parents want insurance companies to cover the cost of ABA therapy, (as well as some other helpful treatments such as occupation therapy and speech therapy). The parents want coverage for treatments for mental-health conditions to be equal to the coverage for treatment for chronic medical conditions. They don’t want a limit placed on the number of visits for treatment.
Insurance companies are reluctant to cover the amount of therapy that is truly needed. Some are starting to come around, though. Group Health Cooperative is one of several insurance companies named in the lawsuit. They are awaiting clarification from a judge, but are suspending coverage limits. This means parents of kids who need ABA treatment or visits to mental-health practitioners will no longer get stuck paying out of pocket for those treatments after a coverage limit was hit.
Group Health is also among the insurers that have agreed to stop another troublesome way of handling coverage. In the past, they were requiring patients to have “significant, measurable improvement” within a 60 day period. If that wasn’t shown, then the insurer would not continue to cover the therapy. Some insurers have stopped doing that.
Other insurance companies are not being reasonable, and are probably going to face difficulties as the class-action lawsuits go through the court system. The insurance commissioner for the state of Washington, where the class-action lawsuits are taking place, is working on a regulation that ensures that consumers will get the coverage they are entitled to. It will put in place a mental health parity law which would prohibit insurers from placing limitations on mental health treatment (that are not in place for physical health treatment).
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