Blue Cross Settles|With Autistic Children

SEATTLE (CN) - Premera Blue Cross will cover neurodevelopmental therapy for autistic and developmentally disabled policyholders regardless of their age, remove treatment caps and pay $3.5 million for past claims, under a settlement agreement to three class actions in state and federal courts from parents of autistic children.

Premera and its subsidiary LifeWise Health Plan of Washington restricted certain therapies, including speech, physical and behavioral therapy, for autistic people and limited therapies to children older than 7, according to the lawsuits.

The class claimed this violated the Washington Mental Health Parity Act, which requires health plans in the state to cover services to treat mental disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The settlement came after five days of "arduous negotiations," and "fundamentally changes the insurance landscape for all of Premera's Washington insureds with developmental disabilities and autism," according to the 65-page settlement.

Premera agrees to provide "medically necessary" therapies, including Applied Behavioral Analysis, for DSM conditions.

"Consistent with this broad coverage right, Premera has agreed not to impose any outright exclusion or age limitation on such coverage. Moreover, Premera has further agreed not to impose any visit limitations or monetary caps on medically necessary neurodevelopmental therapies," according to the settlement.

The insurer will set up a $3.5 million settlement fund "to pay for past claims related to neurodevelopmental therapy, attorney fees, costs, incentive awards and costs of administration."

The settlement must be approved by the judges in the three cases.

The complaints were filed by Sirianni Youtz Spoonemore Hamburger of Seattle between 2011 and 2013.

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