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Appellate Court Considers Whether Insurance Companies Should Cover Disputed Autism Treatment

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LOS ANGELES (CBSLA.com) — A treatment for children with autism and whether insurance companies are obligated to cover it was considered by a state appellate court Wednesday.

The case regarding applied behavior analysis has been long-running dispute between families, covered by Medi-Cal, Healthy Families and Calpers, and insurance companies. The outcome of the case could affect more than 13,000 children with autism in California.

Applied behavior analysis, or ABA, “is a system in which every moment and action by the child is monitored and rewarded by the therapist on a one-to-one relationship for periods of 35, 40 hours a week,” plaintiffs attorney Fred Woocher said. Insurers often deny claims involving applied behavior analysis, according to the lawsuit.

An attorney representing an insurance company says that the therapy is denied when it is administered by a behavioral health practitioner, rather than a doctor.

According to Pat Sturdevant of the state Department of Insurance, these behavioral health practitioners are highly qualified.

“They typically have 3,000 hours of experience and degrees in order to get certified by a nationally accredited board,” she said.

Sturdevant says the treatment is potentially life changing and should be covered.

“For thousands of children who receive this treatment as toddlers, they can be mainstream by first grade. They can overcome an autism diagnosis,” she said.

The appellate court has 90 days to issue a ruling. The plaintiffs say if they lose, they plan to bring the case to the state Supreme Court.

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