SACRAMENTO, CA — A consumer advocacy group filed a lawsuit against the California Department of Managed Care, saying it has wrongfully allowed health insurance companies to decline payment for the treatment of autism.
The lawsuit, filed by Consumer Watchdog in Los Angeles Superior Court, claims DMHC has permitted the denial of “critically needed, medically necessary” treatments. The advocacy group alleged Department Director Cindy Ehnes illegally permitted insurers to deny coverage for Applied Behavioral Analysis, a common autism treatment, in violation of the California Mental Health Parity Act. Also, DMHC improperly withheld public documents requested by Consumer Watchdog, it claims.
The lawsuit seeks to force DMHC to bar insurers from refusing to cover medically necessary ABA treatments. If successful, it would also compel the department to release records to “expose the full extent of DMHC’s violations.”
“Health insurers want to re-write the law to benefit their bottom line and the regulators are holding the pen,” Pam Pressley, Consumer Watchdog’s litigation director, said in a statement. “California’s mental health laws are clear: Doctors get to decide whether care is needed, not insurance company bureaucrats or government lawyers.”
In a statement, spokeswoman Lynne Randolph defended the department’s record.
“We have explicitly told health plans that they may not exclude any particular therapies or treatments for Autism Spectrum Disorder that have been determined to be health care services and are administering the consumer complaint process according to law,” Randolph said.
Health maintenance organizations and most Blue Cross Blue Shield plans are regulated by DMHC. Other plans are regulated by the Department of Insurance.
More than a dozen states have adopted mandates that address insurance for autism spectrum disorders. According to the Centers for Disease Control and Prevention, one in 150 American children has autism, and almost one in 94 boys.
Contact the author, Sean P. Carr, Washington Correspondent, at: [email protected]