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Washington State Insurer Agrees to Cover Occupational, Speech Therapy

By November 9, 2014 October 14th, 2019 No Comments

Following a Washington State Supreme Court Decision, Regence BlueShield has agreed to settle two recent insurance class action lawsuits and ensure coverage for policyholders who require neurodevelopmental disability therapies.

According to AutismSpeaks, the lawsuits were brought by individuals who demanded that their health insurance cover treatments deemed medically necessary to autism patients, speech and occupational therapy. The company also set up a $6 million fund to reimburse policyholders who were forced to pay for such services out-of-pocket when their claims were denied.

In early October, Washington State Supreme Court ruled unanimously in a class action lawsuit that blanket exclusion of Regence BlueShield for treatments on the basis of an autism diagnosis were in violation of Washington’s Mental Health Parity Act of 2005. The company then agreed to settle related class action lawsuit concerning Regence’s self-insured (ERISA) plan.

While Washington State law does not require autism treatments to be covered by insurance companies, the Mental Health Parity Act does. In the lawsuits, Regence claimed that this act did not require them to cover the costs of neurodevelopmental therapies. However, theSupreme Court of that state ruled that “The mental health parity act requires insurers to provide NDT coverage in individual plans when the therapies are medically necessary to treat mental disorders recognized in the DSM-IV-TR if the insurance contract covers medical and surgical services.” They also found the insurers’ arguments to the contrary to be “unpersuasive”.

In light of these settlements, Regence will now cover therapies deemed necessary to treating individuals with mental health conditions such as autism, including speech therapy, occupational therapy, and applied behavior analysis (ABA). AutismSpeaks states that Regence is the last of the state’s three largest insurers to make such a settlement. It is expected that families affected by this ruling will receive funds to reimburse for medical costs by April or May of 2015.

If you believe your valid claim for medical insurance benefits was wrongfully denied, an experienced attorney can help you fight for the care you deserve and are entitled to. To learn more about your rights, contact us for a free legal consultation.

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