Anthem Agrees to Settle
Indiana Autism ABA Case
Anthem agreed to pay approximately $1.63 million to class members and agrees to cease using guidelines that based coverage solely on age.
Settlement also requires reviewers to participate in periodic outside training related to Autism and ABA.
In 2012, Anthem sent letters to their Indiana subscribers with autism stating that medical necessity reviews for ABA therapy services for school aged children, that is children aged 7 and older, would include a review of the child’s school schedule and services as part of the medical necessity review.
The Arc of Indiana objected strenuously to this policy change as a violation of the Indiana Autism Mandate Law, federal mental health parity law (also called MHPAEA), as well as federal insurance laws called ERISA laws.
The Arc of Indiana and Dan Unumb, President of The National Autism Law Center, attempted to work with Anthem and state regulators to address concerns, including a pattern of ABA therapy denials that appeared to be based solely upon age and not the person’s clinical presentation or the standards of medical treatment for ASD.
Despite almost three years of on-going advocacy by The Arc of Indiana and Mr. Unumb to secure regulatory relief the problem remained unresolved and a class action suit was filed in 2015.
The following settlement agreement was made public this month. If approved by the court, about 200 children will receive some payment for ABA therapy that was denied previously. Further, Anthem has agreed to cease using age-based guidelines for medical necessity determinations regarding ABA therapy and autism.
The Arc of Indiana is hopeful that this settlement will lead to decreased discrimination against all persons with autism and developmental disabilities in health insurance plans and will help to encourage insurance carriers and regulators to work with families and their advocacy groups to address potential violations of state and federal laws that protect persons with disabilities from discrimination in health insurance policies and their administration.
Congratulations to the families and attorneys Toby Marshall and Blythe Chandler of Terrell Marshall Law Group and Syed Ali Saeed of Saeed and Little who represented the plaintiffs, and to attorney Dan Unumb, of the National Autism Law Center, for his ongoing efforts in this area.
The Arc of Indiana continues to work to represent families through our Insurance Advocacy Resource Center to address systemic issues in private and public insurance plans that affect individuals with disabilities and their families.
Click here for information from the settlement agreement
The Court still has to approve the settlement. We will provide updates as information becomes available to the public.