The National Law Journal reports on a settlement in Michigan involving payment for autism treatments by insurance companies. Tresa Baldas writes,
In what plaintiffs lawyers are calling a landmark autism case, aMichigan insurance company has agreed to reimburse at least 100families for costs involving treatments for their autistic children.
The $1 million class action settlement from Blue Cross Blue Shieldof Michigan comes amid a legislative wave in which a growing number ofa states are passing laws that require insurance companies to pay forautism treatments and screenings. To date, 13 states have such laws,the most recent being Connecticut, Colorado and Nevada. New Jersey is currently considering an autism bill, and Pennsylvania's law goes into effect July 1.
The June 17 Michigan settlement, meanwhile, has autism advocateshopeful that insurance companies will stop claiming that behavioraltherapy for autistic children is experimental, and start paying for it.
"It is a significant victory for the families, obviously, and itmarks a trend, hopefully, that insurance companies will start to lookat autism treatment differently," said Areva Martin, an attorney at LosAngeles-based Martin & Martin who is currently handling about 30 autism cases. She believes the labeling of autism treatments as experimental is "absurd." …
In the case, Johns v. Blue Cross Blue Shield of Michigan,filed in the Eastern District of Michigan, the family of an autisticchild sued Blue Cross for allegedly failing to acknowledge that atreatment known as applied behavioral analysis is scientifically valid.ABA therapy attempts to change behavior through positive and negativereinforcements. In the suit, the plaintiffs alleged that Blue Cross' pattern andpractice of characterizing ABA as "experimental" was arbitrary,capricious, illegal and contradicted by many years of scientificvalidation. Blue Cross sought dismissal of the case, but a judge permitted it to go forward.
The case settled shortly after plaintiffs counsel obtained a courtorder requiring Blue Cross to produce documents that validated theeffectiveness of ABA. Among the documents obtained was a draft of a2005 Blue Cross Blue Shield medical policy, which stated: "Appliedbehavioral analysis (ABA) is currently the most thoroughly researchedtreatment modality for early intervention approaches to autism spectrumdisorders and is the standard of care recommended by the AmericanAcademy of Pediatrics, National Academy of Sciences Committee and theAssociation for Science in Autism Treatment, among others."
Blue Cross' documents also stated: "The earlier the disorder isdiagnosed, the sooner the child can be helped through treatmentinterventions." …