Schwarzenegger Administration Sued for Allowing Health Insurance Companies to Deny A...(that ABA is an educational program not...),Health

Date:7/1/2009

that ABA is an "educational" program not covered by health insurance policies. On March 9, 2009, the DMHC issued a memo indicating that the agency would review ABA and other autism treatment denials through the DMHC's internal grievance system as urged by insurers.

Consumer Watchdog has evidence that the DMHC has in fact upheld the insurers' denials of ABA on coverage grounds in violation of the Mental Health Parity Act. That law requires insurers to pay for any "medically necessary" and effective autism treatment -- a decision that must be made by independent doctors, not by insurance company bureaucrats or government lawyers.

Kristie Sepulveda Burchit, mother of Aidan who suffers from autism, joined the group to announce the lawsuit. Kristie's insurer, Blue Cross, first refused to provide ABA in 2008 on the ground that it was not medically effective as a treatment for autism. Kristie requested an IMR and the independent physicians who reviewed her appeal overturned the Blue Cross denial. Then, in 2009, shortly after the DMHC issued its March 9 memo, Blue Cross again refused to pay for Burchit's continued ABA autism treatment, this time on the basis that it supposedly was "not covered" by Kristie's health insurance policy because ABA is an "educational service." Burchit has now appealed the denial to the DMHC through the grievance system and is awaiting a decision from the regulator. Consumer Watchdog said that if it wins the lawsuit, the DMHC would have to order Blue Cross to provide ABA treatment for Aidan.

The suit also alleges that the DMHC and its Director Cindy Ehnes:

• Illegally instituted a policy of denying ABA treatment on the ground that providers were inadequately licensed, despite the fact that the law clearly requires health insurers to cover all medically necessary treatments for autism, including ABA, whenever such services are either provided or supervised by
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SOURCE Consumer Watchdog Copyright©2009 PR Newswire. All rights reserved

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