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Boeing Hit With Class Action Suit Over ABA Denials

(APRIL 20, 2014) -- Aerospace giant Boeing has been hit with a complaint in federal court by its Washington state employees who claim the company's denial of insurance coverage of applied behavior analysis (ABA) for their children with autism violates the federal Mental Health Parity Act. Filed by two families whose sons have autism, "C.S." and "D.Z.", the suit seeks certification as a class action on behalf of Boeing's 81,000 Washington-based employees.

Listed #30 on the Fortune 500 list as the nation's largest aerospace and defense firm, Boeing reported earning $3.9 billion in profits last year on $81.7 billion in revenues. Headquartered in Chicago, half of Boeing's employees are based in Washington. The suit was filed in U.S. District Court in Seattle.

The case has added significance because Boeing self-insures its employee health plan and therefore is regulated under federal ERISA law which is immune from state autism insurance reform laws, such as the law in its headquarters state of Illinois. The suit was filed by Seattle attorneys Ele Hamburger and Richard Spoonemore who have been winning a series of similar federal class action suits in Washington over ABA denials. The complaint alleges Boeing's denial of ABA benefits violates the 2008 Wellstone Domenici Mental Health Parity and Addiction Equity Act as well as its fiduciary responsibilities under ERISA.

Boeing does not expressly exclude ABA coverage in its health plan, but rather has its claims administrators exclude all coverage of ABA therapy through internal policies and restricted provider networks, the complaint alleges.

Boeing’s non-mental health claims administrator, Blue Cross Blue Shield of Illinois (BCBSIL), excluded ABA therapy coverage. When a Boeing employee overturned the denial, according to the complaint, Boeing directed BCBSIL to classify ABA therapy as a mental health service to be administered by Value Options, which administers Boeing’s mental health claims.

Boeing directed Value Options to limit its provider network in Washington state to exclude licensed ABA agencies, the plaintiffs assert. 

"The effect of Boeing/Value Option’s failure to include in its network any licensed ABA agencies in Washington state is the same as a blanket exclusion," according to the complaint. "It is impossible for plaintiffs and the proposed class to obtain coverage for the ABA therapy services they need because Boeing will not contract with any providers who can deliver it."

The Mental Health Parity Act does not require Boeing to cover mental health services; rather it requires employers if they do choose to provide mental health coverage -- as the Boeing plan does-- to cover the benefits “at parity” with medical benefits. ERISA requires Boeing to abide by the Mental Health Parity Act and other regulation in administering its plan.

"By applying a blanket, hidden exclusion of ABA therapy to treat (autism), in violation of the Parity Act and its regulations, Boeing is  systemically  and  uniformly  failing  to  properly  administer  its  Plan," according to the complaint. "It is also breaching its fiduciary duties to plaintiffs and class members, who have not received the benefits to which they are entitled."

The suit seeks a court order stopping Boeing from denying ABA coverage in its health plan and requiring reimbursement for past claims

 

This lawsuit seeks remedies for Boeing’s breach of fiduciary duty under ERISA and its failure to properly administer the terms of Plan, as modified by the Parity Act and its implementing regulations.  It further seeks to recover the benefits that have been wrongfully denied to plaintiffs and the class they seek to represent.  It also seeks a court order declaring Boeing’s exclusion of coverage for ABA therapy to treat ASD through a restricted network of providers void and unenforceable.   The lawsuit further seeks an injunction to prevent any future or ongoing efforts by Boeing to use and enforce any blanket exclusions of ABA therapy to treat ASD.

The class consists of all individuals who have  been,  are,  or  will  be  Washington  state  participants  or   beneficiaries under The Boeing Master Welfare Plan that have been, are or will be in effect or renewed