Blue Cross has settled a lawsuit brought by parents of children with autism, reimbursing them for the costs of therapy they had to pay out of their own pockets.
Hopefully, this will become a landmark settlement, providing relief to thousands of families who are paying for services which currently are not covered by their insurance.
The suit, filed in Detroit, alleged that Blue Cross refused to pay for Applied Behavioral Analysis (ABA) therapy for autistic children on the grounds that it was “experimental.”
Blue Cross policies exclude experimental therapies for a variety of conditions. The plaintiffs in the current suit, Johns v. Blue Cross Blue Shield of Michigan, argued that characterizing ABA as experimental was arbitrary, capricious, and possibly even illegal.
John Conway and Gerard Mantese, attorneys for the plaintiffs, said in a statement that ABA is "supported by science and is not 'experimental.'" The therapy is used to help autistic children develop the deficient verbal and social skills that are hallmarks of the disease.
In the settlement, Blue Cross agreed to reimburse the families of more than 100 autistic children who paid for their own behavioral therapy over the past six years. Included in the settlement are families covered by a Blue Cross policy who never actually submitted a claim.