Insurer ordered to cover therapy for autistic kids


For the last three years, two Seattle lawyers have been working to force health insurers in Washington to improve coverage of therapies for autistic children.

Their latest success is against Regence BlueShield, in a court case brought by Disability Rights Washington and the family of a 9-year-old boy with autism who was denied coverage for speech and occupational therapy.

Friday, U.S. District Judge Richard A. Jones ruled that Regence’s blanket exclusion for treatments of medically necessary neurodevelopmental therapies, including speech and occupational therapy, for children over the age of 6, violates Washington’s Mental Health Parity Act of 2006.

Ele Hamburger and Rick Spoonemore of the Sirianni Youtz Spoonemore law firm have filed eight similar class-action lawsuits in state and federal courts against insurers, including Group Health Cooperative, Molina Healthcare, Premera Blue Cross and state programs such as Medicaid and the Uniform Medical Plan, which provides health coverage to public employees.

However, Spoonemore said Friday’s preliminary injunction is the firm’s largest injunction yet and could cover tens of thousands of children.

Regence officials were not available for comment Saturday.

According to court documents, Friday’s injunction ensures that during the remainder of the class-action lawsuit, Regence will not deny coverage for the young boy’s, “or any putative class member’s, requests for neurodevelopmental therapy benefits to treat a mental health condition based on the age exclusion.”

Spoonemore said as the case goes forward, he hopes the court will force Regence to pay all wrongfully denied insurance claims since 2006, not just any claims from here on.

But, he said, such an order wouldn’t come soon.

“At least if it takes a year or two to resolve, going forward autistic children will still be able to get therapy that will be beneficial to them,” Spoonemore said.

The law firm also has a companion case going through King County Superior Court, with Judge John Erlick, over Regence’s state health plans.

 

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