Anthem Denies Coverage for Autism Treatment
About this Case:
TMLG has filed a proposed class action lawsuit on behalf of Indiana children diagnosed with autism spectrum disorders. The lawsuit alleges that Anthem Insurance Companies (“Anthem”) has refused to cover families of autistic children for medically-necessary Applied Behavioral Analysis (“ABA”) therapy. Plaintiffs maintain that Anthem has an unlawful policy of limiting the number of hours of ABA therapy the insurer will approve based on factors unrelated to the medical necessity of the therapy.
Plaintiffs’ allegations include, but are not limited to, the following:
- Anthem’s limits on coverage for ABA therapy violate Indiana’s comprehensive Autism Coverage Mandate, which requires insurers to cover medically-necessary ABA therapy that is approved by a child’s treating physician for the treatment of autism.
- Anthem’s limits on coverage for ABA therapy violate the federal Mental Health Parity Act, which precludes group health insurance plans that cover mental health services from imposing financial requirements or treatment limitations on mental health benefits that are more restrictive than the requirements and limitations imposed on other medical and surgical services.
About ABA Therapy:
ABA therapy, which is widely recognized as one of the safest and most effective treatments for autism, utilizes behavioral conditioning that “involves repetitive, task-and-reward-based activities designed to teach children skills such as imitating others, making eye contact, listening, and appropriately answering questions” (Caroline Giordano, Uses of the Class Action Device in Autism Health Benefits Litigation). By mitigating stereotypic behaviors, such as rocking and heavy breathing, ABA therapy often affords its patients the best avenue to living a happy and productive life. ABA therapy is most effective when provided in accordance with a treatment plan developed by a certified ABA therapist. These treatment plans frequently call for up to 40 hours per week of intensive individualized therapy.
Learn more about ABA Therapy here, at the Center for Autism and Related Disorders.
For more information on the Indiana Autism Coverage Mandate, please visit the Indiana Resource Center for Autism.
To find out more about autism spectrum disorders, visit the National Institute of Mental Health.
Counsel filed the complaint against Anthem April 9, 2015.
Case Contact Information
Terrell Marshall Law Group PLLC
Saeed & Little, LLP