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Parents of Autistic Children Fight Back -- Warn HMO Regulator Against Siding With Insurers Refusing to Pay for Treatment
Date:2/25/2009

Kaiser, Blue Cross and Other Health Insurers Illegally Deny Treatment to Autistic Children, Says Consumer Watchdog

SANTA MONICA, Calif., Feb. 25 /PRNewswire-USNewswire/ -- Parents of autistic children and their families joined Consumer Watchdog today in warning California regulators not to side with health insurance companies that are scheming to avoid paying for autism treatment that is required by state law.

Consumer Watchdog released a letter to the California Department of Managed Health Care warning that it would meet any action to limit such coverage with a court challenge. Regulators must abide by the clear provisions of California law, which requires insurers to cover all medically necessary treatments. Download the letter at: http://www.consumerwatchdog.org/resources/DMHCLetterAutism.pdf.

In the letter to the Department of Managed Health Care, Consumer Watchdog's founder Harvey Rosenfield and litigation director Pam Pressley wrote:

"It is your responsibility to enforce the laws of the state of California as written, and, to that end, to resist and reject pressure from the health care industry seeking to evade those laws. Millions of Californians, including those stricken by autism, and their parents and caregivers, expect no less of you and your staff. Should you fail to perform your duties in this regard, we intend to hold you accountable in the courts."

A recent report from the U.S. Surgeon General concluded that "thirty years of research demonstrated the efficacy" of certain treatments for autistic children. Until very recently, California regulators have ordered insurers to provide the proven treatments.

However, according to a February 12, 2009 report in the Los Angeles Daily Journal, the DMHC is being pressured by industry lobbyists -- and possibly top officials of the Schwarzenegger Administration -- to derail the patient protection process that requires health care companies to provide coverage for treatment that independent doctors determine is medically necessary.

Consumer Watchdog was joined by attorney Scott Glovsky, and the parents of two autistic children -- Andrew Arce and Frank Nagle -- who were denied treatment by their insurer, Kaiser Permanente. Glovsky represents the Arces and Nagels in their lawsuits against Kaiser, and has other lawsuits pending against Blue Cross.

"Kaiser is still dumping their patients, but instead of dumping them on skid row they are dumping the cost of treating autistic children on taxpayers," said Scott Glovsky. "Kaiser is blatantly violating California law and abandoning autistic children at a time when their window within which to recover is closing fast."

Families of autistic children say insurers have turned them away, suggesting that the families turn to the limited resources of the public school special education system for help. Consumer Watchdog said that dumping insured patients on taxpayers by redefining treatment as a school responsibility is reprehensible -- unfair to taxpayers, to public schools, to patients and their families.

The Arces and the Nagles have both successfully challenged their insurers' refusal to provide treatment for their autistic children. In both cases, the state Independent Medical Review (IMR) organization overruled Kaiser's refusal to provide coverage.

Now, apparently in response to pressure from health plans that want to avoid the expense of autism treatment, the state regulators are reportedly contemplating action that would evade the insurance requirement. The net effect will be to force victims of the disease and their families to seek help from taxpayer-funded programs.

Governor Schwarzenegger, who appointed the current Director of the Department of Managed Health Care, has received $1,089,850 in campaign contributions from health insurance companies and HMOs that commonly deny autism treatments. Schwarzenegger, who also is a longtime and vocal supporter of the Special Olympics and mentally handicapped children, must explain why his administration appears ready to support insurers' rejection of state laws, said Consumer Watchdog.

For years insurance companies refused to pay for autism treatments known collectively as Applied Behavioral Analysis (ABA), on the grounds that it was "experimental." However, that has changed in light of new research studies finding proof that ABA is an effective treatment for autism. The American Academy of Pediatrics states that the effectiveness of ABA as a medical treatment is now considered "well documented." As a result, the state Independent Medical Review organization now commonly overturns insurance companies' denials of coverage, and requires insurers to pay for the treatments.

Consumer Watchdog, formerly the Foundation for Taxpayer and Consumer Rights, is a non-partisan and non-profit public interest organization. For more information, go to www.ConsumerWatchdog.org.


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SOURCE Consumer Watchdog
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