SACRAMENTO (August 29, 2013) -- As a result of enforcement action brought by the state of California, United HealthCare of California (UHC) has agreed to stop routinely denying claims for speech therapy and to reimburse its subscribers for out-of-pocket expenses. UHC reached the agreement through a settlement with the California Department of Managed Health Care (DMHC).
“The agreement ensures that UHC enrollees needing speech therapy will receive the care to which they are entitled to under the law,” said DMHC Director Brent Barnhart. “Enrollees will no longer have to pay out of pocket to receive medically necessary speech therapy services and can now seek reimbursement for past out of pocket expenses.”
The settlement is the second major action in California involving denials for autism-related services by private health plans. Earlier this month, Kaiser Permanente agreed to settle a class action lawsuit by reimbursing families up to $9.3 million in claims for speech and applied behavior analysis (ABA) therapy.
UHC routinely denied claims for speech therapy, contending they were an educational rather than medical service. Following a review of consumer complaints, DMHC brought enforcement action agasinst UHC under California's Knox-Keene Act, which requires health plans to cover speech therapy whenever those services are medically necessary.
The settlement, which became effective August 23, requires UHC to notify all current subscribers in its November 2013 subscriber newsletter, as well as all affected former subscribers within 60 days, of their right to medically necessary speech therapy services. The notice will explain how families can request reimbursement for past out-of-pocket expenses for speech therapy.
Subscribers and former subscribers must seek reimbursement before July 30, 2014.