SEATTLE (July 9, 2013) -- Washington State employees whose insurance claims for applied behavior analysis (ABA) for their children with autism were wrongfully denied may soon be eligible for $3.5 million in reimbursement.
In a class action suit brought on behalf of all Washington state workers, the plaintiffs and the Washington State Health Care Authority (HCA) have announced they have agreed to a preliminary settlement creating a special fund to reimburse families for their out-of-pocket ABA expenses.
King County Superior Court Judge Susan Craighead has scheduled a Sept. 5 hearing to finalize the settlement. A $3.5 million common fund would be created for current and former state workers enrolled in the Uniform Medical Plan to seek reimbursement for their out-of-pocket expenses for ABA from January 1, 2006 through December 31, 2012.
Craighead ruled last year that HCA had wrongfully denied ABA benefits under the state's 2006 mental health parity law.
“This settlement will enable hundreds of Washington families to obtain reimbursement for the ABA therapy that they provided for their children, since the Washington Mental Health Parity Act took effect,” said Arzu Forough [left], parent of two named plaintiffs and chief executive officer of the Washington Autism Alliance & Advocacy.
“Many families went into debt, liquidated their pensions, or gave up paying for other important basic needs, just to ensure that their children with autism received this essential therapy," she said. "We hope that this fund will be an example for other insurers as to the right way to redress improper insurance company exclusions of ABA therapy.”
Craighead originally ruled for the families in July 2012, resulting in a partial settlement requiring coverage of medically necessary ABA therapy to treat autism.
“I am pleased that the Health Care Authority was able to respond positively and make this important ABA benefit available to 200,000 Uniform Medical Plan members as well as 1.2 million Medicaid clients,” said HCA Director Dorothy Teeter. “Thousands of Washington families dealing with autism will benefit from these changes.”
The Medicaid settlement is being handled separately by another court. The HCA class action is one of seven pending class action lawsuits over Washington insurers’ limitations or exclusions of autism treatment, including lawsuits against Premera Blue Cross, Regence Blue Shield, and Group Health Cooperative.