Clinical Corner Spring 2018

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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