by ADN

April 29, 2015

Indianapolis, IN – Parents with a 12-year-old boy on the severe end of the autism spectrum are filing a class action suit against their insurance company Anthem for not covering their sons much-needed autism therapy. His mother Kathryn Pierce said her son needs constant guidance and can only speak five words.

After many appeals Anthem Insurance gave the parents an ultimatum: except half of the 40 hours of applied behavioral analysis therapy (ABA) or find a new provider. This was in January. Anthem sent a letter to the family claiming that ABA is not medically necessary, even though the full-time therapy was prescribed by a doctor.
The Elkhart County mother met with news outlet 13 WTHR and said :

“It was devastating because my son needs as much therapy as he can get.”

She later added that:

“It would be easy for me to look for a new insurance company and just switch, like I know other parents have done, but then all those children that have Anthem will just have their hours cut.”

According to the family’s attorney Syed Ali Saeed, Anthems position is that the public school should provide this therapy, not them. Saeed argues it’s against Indiana Mandate.

This is not the first time Anthem denied autism therapy coverage. 13 WTHR’s investigation team, 13 Investigates, first encountered a story like this through a series of reports called “Caring for Canyon,” when they discovered that 8-year-old Canyon’s necessary autism therapy had been denied.

Pierce hopes the class action suit will make difference for all of Indiana’s children on the spectrum.

Contributed by Audrey L. Hollingshead.

Source: Sandra Chapman on the 13 WTHR news website: Indiana parents sue Anthem for denying son’s full-time autism therapy


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