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Blue Cross Blue Shield of Michigan Concludes Autism Lawsuit with Settlement Focused on Families Who Received Early Intervention Services, Not Attorneys
Date:6/19/2009

DETROIT, June 19 /PRNewswire/ -- One month after announcing that it would voluntarily offer its customer groups the ability to purchase coverage for intensive early intervention treatment for autism beginning July 1, Blue Cross Blue Shield of Michigan said today it has concluded a lawsuit involving autism coverage.

"We are the first Michigan health care company to offer the early intervention coverage option," said Jeffrey Rumley, BCBSM vice president and general counsel. "Today the parties to the lawsuit have settled the issues in the lawsuit which relate primarily to past claims."

In the settlement, which is subject to final court approval, BCBSM agreed to provide reimbursement -- subject to copayments and deductibles -- to an estimated 100 families with BCBSM coverage whose children received Applied Behavioral Analysis through the Gift Program at Royal Oak's Beaumont Hospital and are either currently enrolled in the program or received services on or after May 1, 2003.

BCBSM also said it had requested the settlement conference before the court which resulted in the settlement because it believed the case could be resolved except for what it considered outrageous fees requested by the plaintiff attorneys, a sticking point in the negotiations. The settlement resulted in a significant reduction of the attorney fees initially claimed.

"We knew we could resolve this matter to the benefit of the families involved, and are pleased to be able to conclude this matter in a manner that puts the families first who received services from the early intervention program," said Rumley.

Separate from the lawsuit, BCBSM announced on May 11 that it will offer its customer groups the ability to purchase coverage for autism treatment programs that provide intensive early intervention. The new BCBSM benefit option involves coverage for children aged two to five years old who use a treatment called Applied Behavioral Analysis (ABA). The benefit coverage, which consists of up to 60 treatment sessions (usually 12 weeks) can be used once per child, will be available for purchase by customer groups that already have outpatient mental health coverage. The Blues plan to begin offering the coverage to groups on July 1.

BCBSM said it is unaware of any other Michigan insurer providing customer groups with the ability to purchase the benefit option. BCBSM still considers ABA an investigational and experimental treatment.

"We saw a need in the community and moved to find a way to address it," said Thomas Simmer, M.D., Blues senior vice president and chief medical officer, when announcing the new coverage option on May 11. "We developed this coverage option as part of our commitment to improving the health and wellness of all Michigan children and families."

Blue Cross Blue Shield of Michigan is nonprofit and an independent licensee of the Blue Cross and Blue Shield Association.


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SOURCE Blue Cross Blue Shield of Michigan
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