Class Status Granted in Autism Therapy Suit Against Blue Cross Blue Shield of Michigan

A federal judge in Michigan has granted class status in a lawsuit alleging that Blue Cross Blue Shield of Michigan denied coverage for an autism therapy treatment in violation of federal law.

In an opinion handed down July 14, Judge Stephen J. Murphy III of the U.S. District Court for the Eastern District of Michigan approved a request for class certification that will allow the case to incorporate the claims of thousands of plaintiffs whose children may have been denied coverage for a form of autism therapy known as Applied Behavior Analysis, or ABA. The order was issued in the case of Potter v. Blue Cross Blue Shield of Michigan, No. 10-cv-14981.

The suit alleges Blue Cross has illegally characterized ABA therapy as "experimental," despite findings by the U.S. Surgeon General, the National Institute of Mental Health, the American Academy of Pediatrics, and a study commissioned by the Medicare and Medicaid systems that determined ABA is a scientifically valid form of autism treatment. The suit also contends that 26 states require insurers to cover ABA therapy.

Gerard Mantese of Troy, Mich.-based Mantese Honigman Rossman and Williamson, who is representing plaintiffs in the case, called Blue Cross Blue Shield of Michigan's alleged actions "shameful" and said he has asked Murphy to issue an injunction that would force the company to cover ABA treatment.

"Blue Cross needs to stop intentionally ignoring the plethora of medical and scientific evidence showing that ABA is a valid therapy," Mantese said, adding his case argues that if children with autism do not receive ABA-type treatment within a narrow window of time, "they can suffer irreversible damage."

Mantese said this latest suit against Blue Cross Blue Shield of Michigan comes just one year after the company settled a separate case involving ABA coverage that cost the company $700,000 (BestWire, June 3, 2010). "Yet, even after that settlement they continued their policy of denying coverage for ABA," Mantese said.

But Blue Cross Blue Shield of Michigan contends it does provide its policyholders with the option to purchase coverage for ABA-type therapy.

"We recognize that all families care about their children," a Blue Cross Blue Shield spokeswoman said in a statement. "We believe we have been more progressive than other Michigan insurance companies in addressing autism. In 2009, we became the first insurer in the state to offer businesses with our coverage the option to purchase coverage for autism treatment programs that provide intensive early intervention (ABA). To the best of our knowledge, we are the only insurer in Michigan to offer this coverage option to businesses."

New exclusive medicaid planning product
Sales Lead Zeppelin
Get 15 Free Leads
Learn how to make a DOUBLE DI Sale
Estate Planning Failures of the Rich and Famous II
Featured Offers

Tap retirement assets early w/ NO tax penalties - free guide
Help clients tap retirement plan assets early WITHOUT incurring IRS penalties with this [free] 3-Page Download!

Want to connect w/ 15 local prospects for free?
Agents --> Click here to claim your 15 free leads and start connecting with local insurance shoppers who want your help, right now!

{NEW} Elder Care Planning Product
Watch a quick overview of this exciting NEW Single-premium Guaranteed-Issue Whole Life product that can be part of an elder care plan including governement benefits too!

{free report} Annuity Buying Behaviors
CLICK HERE to request your free copy of the Dalbar 2011 Quantitative Analysis of Investor Behavior. Uncover the consumer-trends and skills you need to surpass production goals fast.

When 6% Beats 10%
Get a free Income Rider Comparison Tool right now and save yourself hours comparing options.

Featured Offers
>    Class Status Granted in Autism Therapy Suit Against Blue Cross Blue Shield of Michigan
Most Popular Articles
>    Set It and Forget It? Forget It! Retirement Takes Work, 'Re-Set' Survey Finds
>    Feds Prepare to Judge Health Insurance Hikes
>    Prudential Financial Unit Forms Joint Venture to Originate, Securitize Commercial Real Estate Mortgages
>    Vordel and Oracle Raise the Bar for SOA Deployments
>    With Food Contaminations Occurring More Frequently, Petplan Pet Insurance Urges Vigilance About What Goes into “Fido’s” Bowl
>    Class Status Granted in Autism Therapy Suit Against Blue Cross Blue Shield of Michigan
>    MDRT Survey Reveals 'Honesty' Most Important Trait for Advisors
>    Health Insurance Exchanges Give Purchasing Power to Consumers and Creates a Nearly $200 Billion Market for Insurers, Says PwC
>    Mate: Health Insurance Trumps Lingerie
>    HHS Promises State Flexibility With New Health Exchange Rules
More Popular Articles

Class Status Granted in Autism Therapy Suit Against Blue Cross Blue Shield of Michigan
July 15, 2011 | A.M. Best Company, Inc.
emailEmail   emailPrint   free newsletterFree Newsletter
Copyright:    (c) 2011 A.M. Best Company, Inc.
Source:    A.M. Best Company, Inc.
Wordcount:    552

A federal judge in Michigan has granted class status in a lawsuit alleging that Blue Cross Blue Shield of Michigan denied coverage for an autism therapy treatment in violation of federal law.

In an opinion handed down July 14, Judge Stephen J. Murphy III of the U.S. District Court for the Eastern District of Michigan approved a request for class certification that will allow the case to incorporate the claims of thousands of plaintiffs whose children may have been denied coverage for a form of autism therapy known as Applied Behavior Analysis, or ABA. The order was issued in the case of Potter v. Blue Cross Blue Shield of Michigan, No. 10-cv-14981.

The suit alleges Blue Cross has illegally characterized ABA therapy as "experimental," despite findings by the U.S. Surgeon General, the National Institute of Mental Health, the American Academy of Pediatrics, and a study commissioned by the Medicare and Medicaid systems that determined ABA is a scientifically valid form of autism treatment. The suit also contends that 26 states require insurers to cover ABA therapy.

Gerard Mantese of Troy, Mich.-based Mantese Honigman Rossman and Williamson, who is representing plaintiffs in the case, called Blue Cross Blue Shield of Michigan's alleged actions "shameful" and said he has asked Murphy to issue an injunction that would force the company to cover ABA treatment.

"Blue Cross needs to stop intentionally ignoring the plethora of medical and scientific evidence showing that ABA is a valid therapy," Mantese said, adding his case argues that if children with autism do not receive ABA-type treatment within a narrow window of time, "they can suffer irreversible damage."

Mantese said this latest suit against Blue Cross Blue Shield of Michigan comes just one year after the company settled a separate case involving ABA coverage that cost the company $700,000 (BestWire, June 3, 2010). "Yet, even after that settlement they continued their policy of denying coverage for ABA," Mantese said.

But Blue Cross Blue Shield of Michigan contends it does provide its policyholders with the option to purchase coverage for ABA-type therapy.

"We recognize that all families care about their children," a Blue Cross Blue Shield spokeswoman said in a statement. "We believe we have been more progressive than other Michigan insurance companies in addressing autism. In 2009, we became the first insurer in the state to offer businesses with our coverage the option to purchase coverage for autism treatment programs that provide intensive early intervention (ABA). To the best of our knowledge, we are the only insurer in Michigan to offer this coverage option to businesses."
Tap into retirement assets tax-free

Blue Cross Blue Shield of Michigan currently has a Best's Financial Strength Rating of A- (Excellent).

Blue Cross Blue Shield of Michigan is not the only health insurance carrier to draw fire for allegedly refusing to cover ABA therapy.

Earlier this week, the California Department of Insurance slapped Blue Shield of California Life and Health Insurance Co. with an enforcement action after determining the company failed to comply with the state's mental health law when it denied coverage for the autism therapy approach. But Blue Shield of California's chief operating officer Paul Markovich fired back at CDI, saying the company will cover the autism therapy approach and it is "perplexed" by the enforcement action (BestWire, July 14, 2011).