LOS ANGELES (CN) – The California Department of Managed Healthcare illegally agreed to support insurance providers’ denial of mainstream treatments for autistic children, advocates say.
The department is responsible for enforcing the Mental Health Parity Act, which requires insurance plans to cover the diagnosis and treatment of mental illnesses just like physical illnesses, according to the Superior Court lawsuit.
Instead, Consumer Watchdog and autism specialist Dr. Anshu Batra say the department helped insurers avoid paying for needed autism treatments. The department allegedly caved to insurer pressure to issue an “illegal underground regulation” to reclassify all denials of treatment for autism as “coverage issues” in order to funnel them through the department’s internal grievance system, rather than letting the more transparent independent medical review system handle them.
The department could control the outcome of grievances, while in the independent medical review, a team of doctors reviews each appeal to determine whether insurers denied medically necessary treatments, the lawsuit claims.
The illegal regulation also directed department employees to justify the denial of needed autism treatments because of “inadequate licensure,” even though the Act only requires treatments to be supervised by “licensed or certified professional,” according to the lawsuit.
The department allegedly covered up its actions by denying requests to view public documents that would have exposed its grievance system scam.
The plaintiffs want the court to force insurers to comply with the Mental Health Parity Act and require health plans to provide autism treatment to children who need it.
The lawsuit was filed by Frederic Woocher and Pamela Pressley.