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Premera, LifeWise Agree To Cover Autism Treatment In Washington

May 19, 2014

(May 19, 2014) -- Premera Blue Cross and LifeWise Health Plan of Washington have agreed to settle three class action lawsuits by covering applied behavior analysis (ABA) as well as speech, occupational and physical therapy for autism. The proposed settlements are the latest victories for a Seattle law firm that has used the state's Mental Health Parity Act in a series of legal actions brought against insurers in Washington and Oregon.

As part of the settlements, which must be finalized by the judges presiding over the three cases, a $3.5 million fund would be established for policyholders to gain reimbursement for autism -related services paid out-of-pocket.  

“Some day soon all children in Washington State will have access to the speech, occupational, physical and ABA therapies that they need,” said Rick Spoonemore of Sirianni Youtz Spoonemore Hamburger. “This settlement agreement is a giant leap forward to that day.   Premera should be commended for working with plaintiffs to ensure full coverage and better health care for Washington children.”

Spoonemore's law firm has prevailed in previous cases involving Regence Blue Cross and the Washington State Health Care Authority. New litigation has been filed against Boeing, which employs 81,000 workers in Washington, and the Oregon Public Employees Benefits Board.

The proposed settlement provides for Premera to drop its “developmental disability” exclusion, any age exclusion or treatment limitations to cover medically necessary neurodevelopmental therapy services for autism. The agreement also spells out how Premera will cover medically necessary ABA therapy for autism. The coverage changes would apply to all plans issued by Premera and Lifewise in the State of Washington.

“Today is a proud day for our family,” said John Griffin, a parent of one of the plaintiffs. “Occupational and speech therapy made an enormous difference in our son’s life.  As a result of the settlement, other children with developmental disabilities will now have full coverage for these services.”  

“ABA therapy quite literally changed my then-teenage son’s life,” said Melissa Menti, of Bellingham, Washington, the parent of the plaintiff J.P., a 20-year-old with autism.  “ABA therapy helped my son to develop the behaviors he needs to live on his own and lead a productive and full life. I am so glad that other children will now have a clear way to obtain coverage of ABA.”

Eric Earling of Premera said, “there is a neurodevelopmental therapy mandate in Washington, which requires insurers to cover neurodevelopmental therapy for children under the age of 7 for group plans. Premera did that and more. For people with autism, Premera continued to cover neurodevelopmental therapy past the age of 7 and for members with individual plans.   Premera is forgoing additional appeals in the interest of resolving the matter and moving forward for its members.”