Anthem Insurance Cos. Inc. will pay almost $1.63 million to end
claims that it violated federal benefit laws by placing certain
caps on the coverage of therapy treatments for children with
severe autism disorders.

Anthem also agrees to stop using guidelines that base coverage
of applied behavior analysis therapy for autism solely on an
individual’s age, according to a motion seeking approval of a
class action settlement filed March 23 in the U.S. District Court
for the Southern District of Indiana.

If approved, the settlement will provide relief for at least 201
children and allow class counsel to seek fees of up to $508,345.
The estimated average payment to class members will be
$5,052, with payments ranging from $2.02 to more than $36,000,
according to court documents.

The proposed deal would end a three-year lawsuit that accused the insurance giant of violating federal mental health parity law when it limited coverage for a 13-year-old boy’s autism treatment to 20 hours per week. The settlement comes one year after a federal judge held that Anthem satisfied Indiana’s autism mandate, which requires insurers to cover treatment for autism spectrum disorder, by covering 20 weekly hours of treatment instead of the 40 hours requested. Anthem joins a growing list of companies that have settled claims over coverage of ABA therapy for autism, including United Healthcare Services Inc., T-Mobile USA Inc., and Applied Materials Inc.

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What Is Autism?

Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. About 1 in 44 children has been identified with autism spectrum disorder (ASD) according to estimates from CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network. People with ASD have abilities that very significantly. Autism affects each person differently, making it truly a spectrum disorder. People with autism may behave, communicate, interact, and learn in ways that are different from most other people. Some people with ASD need a lot of assistance whereas others live very independently with little to no support. Individuals with autism typically do not have any identifiable characteristics that set them apart from other people. Some children show autism symptoms within the first 12 months. In others, symptoms may not show up until 24 months of age or later. Some children with autism gain new skills and meet developmental milestones until around 18 to 24 months of age, and then they stop gaining new skills or lose the skills they once had.

Signs and Symptoms

People on the autism spectrum often struggle with social interactions and with communication as well as repetitive and restrictive behaviors.

Learn more about the signs and symptoms of Autism Spectrum Disorder, here.

Learn more about important milestones that your child should reaching, here.

Evaluating your Child

Are you seeing the signs of autism in your child, but don’t have an evaluation yet? Early detection and diagnosis is crucial to improved outcomes and increased success and independence in the long run. You can view our list of early signs and symptoms of autism in babies, toddlers, and young children. Then, you can connect with Lighthouse’s network of professionals that have the expertise to fully evaluate your child for autism.

Find Out more