Portland, OR – U.S. District Judge Michael Simon ruled last week that Providence Health cannot deny coverage of autism therapies on the bases that doing so violated state and federal laws. This ruling could help many Oregon children on the spectrum who desperately need the therapeutic help.
The ruling came about after two Portland based families sued the health insurance company in 2012 after it denied the autism therapy, Applied Behavior Analysis (ABA). If done diligently and daily ABA can help children on the spectrum with learning and social interaction, something most people on the spectrum may have trouble with.
The coverage was originally denied based on wording that stated any therapies relating to developmental disabilities, developmental delays or learning differences could not be covered. This denial is called the Developmental Disability Exclusion and has been on all group plans Providence Health has offered since 2007.
Gary Walker, a Providence Spokesperson had commented that despite the exclusion autism is still covered. Judge Simon disagreed, adding that it appeared that the insurance company only covered the condition itself and not the treatments to help it. As he wrote later to Portland Business Journal:
“For example, Providence could state that it covers depression, but refuse to cover psychotherapy or antidepressant medications, provided that it did not cover psychotherapy or antidepressant medications when those treatments were medically necessary to treat medical conditions.”
The affected families are seeking reimbursement for the out-of-pocket payments, but that lawsuit is still open.
The original article by Dennis Thompsonon the Portland Business Journal website can be found here