State - Detroit Autism advocates push for coverage, may sue Medicaid

DETROIT (AP) -- Activists who want Michigan insurers to offer coverage for behavioral therapy for autistic children are considering suing the state's Medicaid program and insurers to force a change. A class-action lawsuit against Blue Cross Blue Shield of Michigan led to a settlement under which it became the state's first insurer to offer coverage for autistic children. But The Detroit News reported Sunday that most Michigan insurers still don't cover autism therapies. Autism advocates are trying to change that through lawsuits and legislation to take the financial burden off families of services that can cost up to $50,000 annually. A bipartisan task force is conducting hearings around the state. And the Michigan House has passed legislation to require insurance companies to cover the costs of therapy for autistic children, although it has not moved in the state Senate. Some autism activists believe it won't become law. Their attorneys are ready to file lawsuits against Michigan's Medicaid program and other insurers to get children therapeutic coverage. "We're hoping that once we achieve enough of these victories that all of the insurers will realize this therapy is mainstream and effective and should be authorized," Gerard Mantese, a Troy attorney, told The Detroit News. He worked on the Blue Cross Blue Shield suit and is working on litigation against other parties. Many insurers don't cover therapeutic coverage because they deem the therapies experimental. Activists counter that research shows many are proven to be effective, especially when implemented early. "This condition is devastating, not just from a financial perspective but from an emotional and relationship perspective. It just destroys families," said Warren resident Chris Johns, whose son has autism. Autism is a neurological disorder that impairs a person's social, emotional and communication skills. About one in 100 American children have the disorder, according to federal studies, including an estimated 14,000 in Michigan. Since 2001, 21 states have passed laws requiring insurers to provide evidence-based, early intervention autism therapies, according to Autism Votes, an initiative of the advocacy group, Autism Speaks. Two weeks ago, a Wayne County Circuit judge denied a motion by Blue Cross Blue Shield of Michigan to dismiss a case, paving the way for a $125,000 settlement filed by Cheryl Matthews, Mantese said. Matthews, an Oakland County Circuit judge, alleged the insurance company wrongly refused to pay claims totaling $38,000 for therapy for her autistic son. The ruling comes as Blue Cross Blue Shield recently mailed checks totaling $680,000 to nearly 100 families after it agreed to settle a class-action lawsuit last year where families said they were wrongly denied reimbursement for a program for their autistic children. Blue Cross Blue Shield still regards autism therapies as experimental, but the company changed its policy in May 2009 to offer families an option to buy an insurance rider for their children ages 2 to 5 to get 60 treatment sessions, or about 12 weeks. "We felt there was a need out there so we moved to change our policy," Blue Cross spokeswoman Helen Stojic said. Published: Tue, Jun 15, 2010

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