When it comes to health insurance, should autism and other neurodevelopmental disabilities be treated like a sprained back or like diabetes?
In essence, that's the question at the heart of a pile of class-action lawsuits filed against insurers over the past two years by parents demanding equal treatment for mental-health conditions.
The parents say autism and other conditions affecting the brain should be covered like chronic medical conditions are now with no limits on the number of visits for treatment.
Group Health Cooperative, one of several insurers targeted by the lawsuits, has announced that as it awaits clarification from a judge, it is suspending coverage limits. That will apply to neurodevelopmental therapies, behavior-modification programs and visits with mental-health practitioners and therapists for issues such as learning, communication and motor skills disorders.
With rehabilitation services, such as speech therapy, Group Health also agreed to stop requiring patients to have "significant, measurable improvement" within a 60-day period in order to continue therapy.
Group Health has also removed caps and limits on Applied Behavioral Analysis (ABA), a type of therapy of particular interest to families of those with autism-spectrum disorders, such as Asperger syndrome, said Group Health spokesman Mike Foley.
Other insurers, including Premera and the state's Uniform Medical Plan for state workers, still spell out limits for various therapies for neurodevelopmental conditions in coverage information. Ele Hamburger and Rick Spoonemore, the lawyers for the parents, say the others should follow Group Health's example.
In the current case, before U.S. District Court Judge Robert Lasnik, Group Health has argued it can limit neurodevelopmental therapy because it applies the same visit limits to physical-rehabilitation therapy. And Hamburger said Group Health has indicated it will pursue that argument in court.
In the meantime, Sean Corry, a longtime advocate for mental-health parity, said Group Health's decision to suspend limits retroactively to June 1 was "remarkably great news."
In briefs in the cases against insurers' restrictions, Hamburger and Spoonemore argue that visit limits are illegal. Under state and federal mental-health parity acts, they said, visits for treatment of mental-health conditions must be handled like any other medically necessary office or hospital visits.
See the original post here:
Class-action lawsuits demand equal coverage for autism