Dynamic Accident Lawyers: California Health Insurance Laws Limit Improper Denial of Autism Treatment

The California Department of Insurance introduced new regulations regarding autism treatment in 2015 for the purpose of clearing up the confusion of what is medically necessary when it comes to treating autism spectrum disorders.

The new regulations make it easier to enforce autism-related bad faith insurance penalties, such as if health insurance companies fail to comply with the policy by delaying or denying autism treatment services such as Applied Behavorial Therapy (ABA) and IQ testing.

“We have all had frustration with the denials and delays,” said Julie K., senior public policy analyst at the Center for Autism and Related Disorders in Tarzana, Calif. “This really is making the state law and making the public policy clear.”

Autism Treatment and Medical Insurance Coverage

The Centers for Disease Control and Prevention (CDC) estimates that an average of one-in-68 children have an autism spectrum disorder (ASD). There is no cure for autism, but most health professionals agree that early medical intervention austism treatment programs are crucial.

Autism treatment options may include behavioral and educational interventions, complementary and alternative medicine, dietary changes or medications to manage or relieve the symptoms of autism. However, these treatments may be costly.

According to the CDC, “it costs an estimated $17,000 more per year to care for a child with ASD compared to a child without autism. Costs include health care, education, ASD-related therapy, family-coordinated services, and caregiver time. For a child with more severe ASD, costs increase to over $21,000 more per year.”

Some states, including California, require insurers to provide coverage for the treatment of autism. However, opponents to this approach argue that care for individuals with autism is the responsibility of parents and school districts. Others have raised concerns that mandating medical insurance coverage for autism will significantly increase insurance premiums.

Unfortunately, many California health insurance companies such as Cigna Healthcare, may be improperly preventing parents from accessing the necessary treatment for their autistic children.

This has arisen so much that California Insurance Commissioner Dave Jones had to issue an emergency regulation requiring health insurance companies to cover the therapy as “medically necessary treatment” for children with autism.

In 2013, Cigna resolved a bad faith insurance class action lawsuit that alleged the health insurance company improperly denied or delayed coverage for autism treatment with a $2.4 million settlement.

The autism treatment denial class action lawsuit claimed that Cigna had denied insurance claims for autism treatment as far back as November 2004, allegedly deeming autism therapy as “experimental, investigational or unproven.”

California Limits Denial of Autism Treatment

These new bad faith insurance mandates prohibit limits to visits and spending, unless similar benefits are limited, and bureaucratic denials and delays are also prohibited.

Since the medical insurance coverage law became effective, the California Department of Insurance has received 71 bad faith insurance complaints and predicts that another 1,600 individuals have reportedly experienced delays for autism treatment.

“Approval of the mental health parity regulation will help end improper insurer delays and denials of medically necessary treatments for autistic individuals,” said Jones in a statement.

“This regulation provides clear guidance to the industry, stakeholders and consumers on the requirements of the Mental Health Parity Act,” he added.

If you have a valid insurance claim that you feel has been wrongfully denied by Cigna or another health insurance provider, an attorney experienced in bad faith insurance can be help you to recover the autism treatment benefits you deserve.

Join a Free California Bad Faith Insurance Lawsuit Investigation

A bad faith lawsuit investigation has been launched into allegations that some California insurance companies are refusing to pay valid medical claims or offering to pay far less than the claim is worth. Some of the companies being investigated for potential violations include:

Aetna
Anthem Blue Cross
Blue Cross of California
Blue Shield of California
Cigna
Health Net
Kaiser
Secured Horizons
United Healthcare
WellPoint
Others

If you or a loved one were denied coverage for autism treatment, mental health treatment, plastic surgery skin removal after weight loss, proton therapy for cancer, or some other medically necessary treatment, you may have a legal claim.

Get a Free Case Evaluation Now

We tell you about cash you can claim EVERY WEEK! Sign up for our free newsletter.

Email*
State*
selectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific

jQuery(document).ready(function($){gformInitSpinner( 5, ‘http://11284-presscdn-0-40.pagely.netdna-cdn.com/wp-content/plugins/gravityforms/images/spinner.gif’ );jQuery(‘#gform_ajax_frame_5’).load( function(){var contents = jQuery(this).contents().find(‘*’).html();var is_postback = contents.indexOf(‘GF_AJAX_POSTBACK’) >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find(‘#gform_wrapper_5’);var is_confirmation = jQuery(this).contents().find(‘#gform_confirmation_wrapper_5’).length > 0;var is_redirect = contents.indexOf(‘gformRedirect(){‘) >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;if(is_form){jQuery(‘#gform_wrapper_5’).html(form_content.html());setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery(‘#gform_wrapper_5’).offset().top); }, 50 );if(window[‘gformInitDatepicker’]) {gformInitDatepicker();}if(window[‘gformInitPriceFields’]) {gformInitPriceFields();}var current_page = jQuery(‘#gform_source_page_number_5’).val();gformInitSpinner( 5, ‘http://11284-presscdn-0-40.pagely.netdna-cdn.com/wp-content/plugins/gravityforms/images/spinner.gif’ );jQuery(document).trigger(‘gform_page_loaded’, [5, current_page]);window[‘gf_submitting_5’] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find(‘#gforms_confirmation_message_5’).html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery(‘#gform_wrapper_5’).replaceWith(” + confirmation_content + ”);jQuery(document).scrollTop(jQuery(‘#gforms_confirmation_message_5’).offset().top);jQuery(document).trigger(‘gform_confirmation_loaded’, [5]);window[‘gf_submitting_5’] = false;}, 50);}else{jQuery(‘#gform_5’).append(contents);if(window[‘gformRedirect’]) {gformRedirect();}}jQuery(document).trigger(‘gform_post_render’, [5, current_page]);} );} ); if(typeof gf_global == ‘undefined’) var gf_global = {“gf_currency_config”:{“name”:”U.S. Dollar”,”symbol_left”:”$”,”symbol_right”:””,”symbol_padding”:””,”thousand_separator”:”,”,”decimal_separator”:”.”,”decimals”:2},”base_url”:”http:\/\/topclassactions.com\/wp-content\/plugins\/gravityforms”,”number_formats”:[],”spinnerUrl”:”http:\/\/topclassactions.com\/wp-content\/plugins\/gravityforms\/images\/spinner.gif”};jQuery(document).bind(‘gform_post_render’, function(event, formId, currentPage){if(formId == 5) {gformInitChosenFields(‘#input_5_2′,’No results matched’);} } );jQuery(document).bind(‘gform_post_conditional_logic’, function(event, formId, fields, isInit){gformInitChosenFields(‘#input_5_2′,’No results matched’);} ); jQuery(document).ready(function(){jQuery(document).trigger(‘gform_post_render’, [5, 1]) } );

Top Class Actions is a Proud Member of the American Bar Association

american-bar-association