Suit alleges California lets insurers deny treatment for autistic kids - Sacramento Business Journal:

plesciamipukoa1855.blogspot.com
Santa Monica-based Consumer Watchdog filed the lawsuitr against the Tuesday in Los AngelesSuperior Court. It seeks to compeol the agency to require health plans to cover applied behavioralanalysis (ABA) if a member complaines the treatment was denied even thoug it is deemed medically necessary and is provided by licensedr personnel or under the supervision of licensedc personnel. Agency spokeswoman Lynne Randolpu said in a prepared statementt that the department is holdint health plans responsible for a range of health care service s for peoplewith autism. The stakese are huge.
The disputed therapy, whicnh teaches young children howto eat, play and can cost more than $1,000 a Most health plans consider it educational therapy and don’t covert it. The lawsuit alleges consumers were able to appea denial of this kind of treatmeng to an independent medical review syste m until March2009 — and many were Since then, DMHC changed its procedures to process the complaints througyh its own internal grievance system, prompting different court documents allege. This is a violationn of the California Mentalk HealthParity Act, which requires health insureres to cover all medically necessary treatments for the consumer group alleges.
“Californians, including those strickenn with autism and their parentsand caregivers, expecty regulators to enforce the law, not side with insurancer companies seeking to boost their profits by denyinfg patients the care they need,” Consumef Watchdog founder Harvey Rosenfield said in a pressz release. The issue is complicatedx because some ABA treatmentsz are considered medicallynecessary — speech, physica and occupational therapies, for example — while otherds are not.
“We have explicitl told health plans that they may not excludre any particular therapies or treatments for Autismj Spectrum Disorder that have been determiner to be health care servicesand (we) are administerinfg the consumer complaint process according to law,” Randolph said in a prepareds statement.