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Sunday, January 12, 2014

Affordable Care Act and Autism Legislation






Effective January 1, 2014, the following states do not require insurers to cover additional autism services that are in excess of the coverage outlined under the Affordable Care Act program: Arkansas, Michigan, Vermont and Virginia.  


The legislation reads accordingly,

"The law specifies that on or after January 1, 2014, to the extent that these provisions require benefits that exceed the essential health benefits specified under the federal Patient Protection and Affordable Care Act, the benefits that exceed the essential health benefits shall not be required of a health benefit plan when the plan is offered by a health care insurer in the state through the state medical exchange."




I have to be honest when I say that nothing brings me more joy (except my children, of course) than when big insurance companies are finally made to pay up after denying coverage to people in need.
So with a big smile on my face I pass on this information about Kaiser Permanente in California.  This insurer was ordered to pay 9 million dollars for the monies that families paid to obtain speech services for their children.

http://www.bizjournals.com/sacramento/news/2013/08/08/kaiser-to-pay-9m-to-settle-autism-suit.html

Now, this was a class action lawsuit.  However, if this lawsuit is closed, you may still be able to sue on your own.  It is always worth consulting an attorney.





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All across America, large and small insurance companies continue to deny coverage for autism services.   Some insurers have lost a few lawsuits and have decided it would be too costly to continue denying therapeutic services that can mean the difference between a mainstream education and a special education for a child on the spectrum.  However, why do we continue to hear about the parents repeatedly fighting for coverage?  Part of the reason lies in the fact that if a class action lawsuit is not filed and lost, some insurers are willing to take a chance on denying the coverage on a case by case basis.  They rely on the probability that parents will simply give up the fight, which more often than not is the case.  

As recent as Decenber 2013,  Providence Health Plan, a Catholic insurer, is fighting a class action status filing on the basis that they do not cover developmental disabilities, and of course, autism is the third largest developmental disability according to the CDC.  Previously, Providence tried to deny coverage stating the Applied Behavior Analysis was an experimental treatment, which has time and again been proven to not be true.  






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