Accountability

HIV-Positive Individuals Seek to Certify a Class Action in Discrimination Case Against CVS

Internal Documents Show CVS Adopted an HIV Prescription Drug Mail-Order Program to Increase Revenue Despite Health Risks Los Angeles, CA - CVS was aware of the threat its prescription drug mail-order...

HIV-Positive Consumer Joins Lawsuit Against Pharmaceutical Giant Gilead Over Price Gouging

Los Angeles, CA -- An HIV-Positive consumer has joined a federal lawsuit against pharmaceutical manufacturer Gilead Sciences in a complaint alleging unfair and anti-competitive behavior in violation of multiple...

California Court Supports Coverage For Autism Therapy

(Reuters) - A California appeals court has ruled that state regulators and health insurers cannot deny coverage for an intensive autism treatment on the grounds that the therapy was...

California Court of Appeals Ends State Regulator’s Discrimination Against Autistic Children

Santa Monica, CA - Parents of autistic children scored a major victory in a California Court of Appeal decision issued late yesterday, which now bars state regulators and health...

Calif. Appeals Court Again Says Plans Must Cover Autism Care

Law360, Los Angeles (April 23, 2014, 9:42 PM ET) -- A California appeals court on Wednesday again held that the Department of Managed Health Care is required by law...

Court Grants Rehearing in Autism Case

This week the California Court of Appeal granted Consumer Watchdog's petition for rehearing in its seminal lawsuit against the Department of Managed Health Care over treatment for autistic children. Consumer...

Autism Ruling Change Requested

This week Consumer Watchdog filed a brief urging the California Court of Appeal to reconsider part of a recent ruling ending autism discrimination that could be read to put...

Ruling’s Effect on Autism Coverage

The Second District Court of Appeal in Los Angeles last week ruled that the Department of Managed Health Care cannot use licensure as a basis for denial of a...

KNBC TV-4 Los Angeles – Autism Health Insurance Victory

The California Court of Appeals has ruled that all insurance plans will now have to cover perhaps the most effective treatment for autism, whether the therapist is licensed or...

KCAL TV-9 Los Angeles – CA Appeals Court Rules Public Insurance Must Cover Autism Treatment

https://www.cbsnews.com/losangeles/news/calif-appeals-court-rules-public-insurance-must-cover-autism-treatment A therapy for children with autism must be covered by public insurance companies, a California appeals court has ruled. Applied Behavior Analysis — or ABA — "is a system in...

Autism Discrimination Barred

We're very proud of the legal team's recent victory in a lawsuit to bar discrimination against children. The California Court of Appeal's decision ended the Department of Managed Health Care’s...

Court of Appeal Rules HMO Regulator Cannot Discriminate Against Autistic Children by Erecting Hurdles to Key Treatments

Santa Monica, CA -- In a complex opinion issued yesterday, the California Court of Appeal ended the Department of Managed Health Care’s (DMHC) discriminatory practice of allowing HMOs to deny treatment for autistic children of state employees and low-income families enrolled in the Healthy Families program on the basis that such treatment can only be administered through state-licensed providers.

KCAL TV-9 CBS, Los Angeles – Consumer Watchdog argues for proper autism treatment before the CA Court of Appeals

A case before the California Court Of Appeals could affect the healthcare treatment of over 13,000 children with autism.

KNBC TV-4 Los Angeles – Consumer Watchdog fights to guarantee children with autism get the treatment they need

Consumer Watchdog fights to guarantee children with autism get the treatment they need

Differing Interpretations Of Health Law At Heart of Autism Lawsuit

LOS ANGELES - Two state agencies that regulate slightly different kinds of health insurance plans are taking dramatically different views on the same state law that requires mental health...

Court Takes Up Whether Firefighters’ Kids Get Autism Coverage

A panel of the California Court of Appeal today took up the long standing dispute about insurance companies’ obligations to cover a critical treatment for autistic children. At stake is whether the autistic children of many firefighters, cops and state employees will get the appropriate care when they need it.

Treatment for More Than 13,500 Autistic Children In California Hangs in Balance at Tuesday Court Hearing

Santa Monica, CA– A California Appellate Court in Los Angeles will consider a long-running dispute at a Tuesday afternoon hearing about insurance companies’ obligations to cover a critical treatment for autistic children.  The case, brought by the non-profit Consumer Watchdog, will also determine if families previously forced to pay tens of thousands of dollars out-of-pocket for autism treatment should be re

KCBS-TV 2 LA – Consumer Watchdog Goes To Court For Autistic Children Denied Coverage By Their Health Insurer

Private insurance companies are required to cover an expensive treatment for children with autism, but that same coverage is being denied to children insured under MediCal and CalPers policies. As CBS 2's Randy Paige tells us, a court battle is underway to try and change that.

Independence Day Reprieve For Hundreds of Thousands of Consumers Enrolled in Blue Shield Insurance Policies To Be Closed This Week

Consumer Watchdog praised Insurance Commissioner Dave Jones' announcement today opposing Blue Shield's plan to close 23 health insurance policies, and echoing concerns raised by Consumer Watchdog in a recently-filed class action lawsuit.

Blue Shield of California Sued for Pushing Policyholders into Bare Bones Coverage and Hiking Premiums

Blue Shield has used enormous rate hikes, and the threat of rate increases, to force patients into lower-benefit and higher-deductible health coverage in violation of state law, according to a class action lawsuit filed today by Blue Shield policyholders and consumer advocates.

Autism: Law Make Insurers Cover Therapy – For Now

Parents of children with autism lauded the governor's decision to sign into law a bill that requires health insurers to cover behavioral health treatments for their kids, but questions...

Insurers’ Critics See Case As A Boost

Appeals court sides with patient, giving hope to others

Health insurance providers can expect new litigation - and pressure from existing litigants - after a federal appellate court decision on Friday said they are responsible for covering mental health treatment on par with care for physical conditions.

Multiple lawsuits and a piece of state legislation are already underway to force insurance coverage of treatment for autism, and advocates fighting for that coverage say Friday's ruling brings momentum to their cause.

California Regulator Erred in Issuing Treatment Memo, State Judge Rules

SACRAMENTO, Calif.—The California Department of Managed Health Care (DMHC) overstepped its constitutional authority in issuing a memorandum to health insurance companies on how to handle consumer complaints about autism treatment, a state judge ruled Dec. 30 (Consumer Watchdog v. California Department of Managed Health Care, Cal. Super. Ct., No. BS121397, 12/30/10).
 

Court Slaps Agency Over Autism Regulation

LOS ANGELES - A Superior Court judge overseeing an unusual consumer lawsuit against state regulators found that a 2009 policy that has allowed health insurance plans to more easily deny coverage for some costly autism therapies constituted an "underground regulation," but has declined to intervene.

Court Ruling Finds Regulator Overstepped On Autism

Court ruling finds regulator overstepped on memo to insurers about autism treatment complaints

 

Court Rules That Schwarzenegger Administration Illegally Changed State Policy Regarding Autism Coverage

On Other Key Issues, Ruling Leaves Autistic Children at Risk; Brown Administration Urged to Take Action

A Los Angeles County Superior Court issued a ruling late Monday finding in part that the Schwarzenegger Administration illegally changed state policy relating to autism coverage without following the required public process.  However the ruling failed to address key legal issues, including California’s mental health parity law, and leaves children at risk of additional coverage denials for autism treatments, according to Consumer Watchdog.

Full Steam Ahead: Autism Trial on Monday, Dec. 13th

We have cleared the final hurdle before going to trial next Monday on our suit against the Department of Managed Health Care (DMHC), the state's largest health insurance regulator, for illegally siding with insurance companies over autism treatment delays.

Round Two Goes to Consumer Watchdog in Autism Battle

Ever play a game with a poor loser who tries to change the rules when the chips are down? The Department of Managed Health Care (DMHC) is trying to do...

Lawsuit to stop “scandalous” denials of Autism treatment set for trial in December

What does "health care reform" promising "access" to health care services really mean if children can be denied the medical care they need? California HMOs and health insurers are denying...

Schwarzenegger veto harms kids with Autism

Californians, including those stricken by autism, and their parents and caregivers, expect regulators to enforce the law, not to side with insurance companies seeking to boost their profits by denying patients the care they need.

Consumer Watchdog Sues California Department of Managed Health Care for Permitting HMOs to Deny Treatments to Autistic Children after Secret Meetings Between State Employees...

Consumer Watchdog Sues California Department of Managed Health Care for Permitting HMOs to Deny Treatments to Autistic Children after Secret Meetings Between State Employees and HMO Execs

Los Angeles Superior Court BS 121397

UPDATE: Court Issues Preliminary Ruling Holding Autism Treatment Denials, Agency Actions Illegal.

State Approves Autism Claims

Several families of autistic children denied treatments by their health plans have won administrative appeals, in a sign that a recent court ruling scrutinizing regulators may be having an effect on the state's handling of the cases.

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Court Advances Autism-Treatment Lawsuit Against California Regulator

LOS ANGELES, CA -- A lawsuit claiming the California Department of Managed Care improperly allowed health insurers to decline payment for autism treatments will proceed to trial after a Los Angeles County Superior Court judge rebuked the state in a preliminary ruling. A Consumer Watchdog representative said regulators should stop denying coverage on the grounds that ABA providers are certified not by the state but by a national board. Continuing to do so would risk legal damages, the advocacy group said in a statement. "The DMHC has to change its practices going forward, and the department should immediately reverse its previous denials," Pam Pressley, litigation director for Consumer Watchdog, said in a statement. "Gov. Schwarzenegger, a long-time and vocal supporter of the Special Olympics and developmentally disabled children, should require his regulators to abide by the law."

Suit Challenges State’s Autism Practices

A lawsuit alleging state regulators allow insurance companies to deny necessary but expensive treatment for autistic children in violation of state law has enough merit to proceed to trial, a Los Angeles Superior Court judge has ruled. The lawsuit, filed in July by Santa Monica-based Consumer Watchdog, seeks to compel the California Department of Managed Health Care to order health plans to cover applied behavioral analysis (ABA) if a member complains the treatment was denied though it is deemed medically necessary and is provided by licensed personnel or under the supervision of licensed personnel.

Autism Treatment Claims Dispute Can Go To Trial

A lawsuit seeking health care coverage for the use of applied behavioral analysis in the treatment of autism has been cleared for trial by the Los Angeles County Superior Court. Consumer Watchdog et. al. vs. California Department of Managed Health Care et. al. involves Kaiser Permanente’s denial of coverage for a child’s ABA treatment because the provider wasn’t licensed by the state. The Oakland, Calif.-based health maintenance organization cited regulations issued by the California Department of Managed Health Care as its reason for denying coverage for ABA treatment.

Judge To Schwarzenegger Administration: Autism Denials Illegal

Santa Monica, CA – A Los Angeles County Superior Court judge issued a ruling finding that the Schwarzenegger Administration has illegally sided with health insurance companies that deny access to care for autistic children.  A memo circulated by the Schwarzenegger Administration to health insurers was also ruled to be an illegal “underground regulation” because it violated state law requiring a public process for changing insurance regulations.

Ruling Deals A Blow To Denials Of Autism Treatment

Refusing to cover a costly behavioral therapy because the care provider lacks a state license violates California law, a Los Angeles County judge finds.

Consumer Watchdog President Jamie Court said the ruling was reason enough for Gov. Arnold Schwarzenegger to order the department to stop fighting the suit and start ordering insurers to provide the treatment to their autistic members. "For an administration that is so involved with the Special Olympics to not understand the harm it's causing every day that an autistic child doesn't get the care they need, is not only legally inexcusable, but morally reprehensible," Court said.

California Sued Over Regulation of Autism Treatments

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.

Suit Alleges California Lets Insurers Deny Treatment For Autistic Kids

A nonprofit consumer group has filed a lawsuit against state regulators alleging they allow insurance companies to deny necessary but expensive treatment for autistic children in violation of state law. Santa Monica-based Consumer Watchdog filed the lawsuit against the California Department of Managed Health Care Tuesday in Los Angeles Superior Court.

Autism Patients’ Treatment Is Denied Illegally, Group Says

Consumer Watchdog asks a judge to order the state Department of Managed Health Care to enforce the law and require insurers to serve autistic members. The agency says it's doing its job.

"Californians, including those stricken with autism and their parents and caregivers, expect regulators to enforce the law, not to side with insurance companies seeking to boost their profits by denying patients the care they need," said Harvey Rosenfield, founder of the nonprofit Consumer Watchdog and author of the landmark automobile insurance reform initiative Proposition 103.

Group Sues Calif. Regulators Over Autism Care

Consumer Watchdog, a Santa Monica group that monitors insurance practices, has asked the court to order the Department of Managed Health Care to require insurers to provide autistic children with treatments ordered by their doctors. The group also wants the department to turn over records showing the agency's violations in this area.

State Sued Over Handling of Autism Complaints

LOS ANGELES, CA -- California regulators are being challenged in court for siding with insurance companies, rather than patients, over some costly autism therapies. In a lawsuit filed Tuesday, consumer advocates complain that the Department of Managed Health Care broke state law by precluding expert doctors from deciding whether an insurer must provide treatments for autism.

Watchdog Group Sues State Agency Over Care For Kids With Autism

The non-profit Consumer Watchdog and a doctor who works with autistic children are suing the California Department of Managed Health Care. Their lawsuit alleges that the agency is allowing insurance companies to refuse to pay for effective but expensive treatments for kids with autism.

State Regulators Sued For Allowing Insurers to Deny Autism Care

"Point of the suit is simply -- it's doctors, not insurance company bureaucrats or politicians or government lawyers, that should decide what kind of care a child could get," says Jerry Flanagan with Consumer Watchdog.

Suit Alleges Autism Care Routinely Denied

Wednesday, the group Consumer Watchdog sued the California Department of Managed Health Care, alleging the agency and its director have allowed private health insurers to refuse to provide health care to autistic children like Aidan. "The department responsible for overseeing many of the state's insurance companies has been siding with insurance companies and denying access to necessary autism care," said Jerry Flanagan, Consumer Watchdog.

Schwarzenegger Administration Sued for Allowing Health Insurance Companies to Deny Autism Care

Santa Monica, CA -- The mother of an autistic child joined Consumer Watchdog and its attorneys today to announce a lawsuit against the California Department of Managed Health Care (“DMHC”), the Schwarzenegger Administration agency responsible for regulating many of California’s health insurers.  The suit alleges that the DMHC has wrongfully allowed insurance companies to refuse to pay for autism treatments, resulting in the denial of critically needed, medically necessary treatment for autistic children.

State Agency Sued Over New Policy On Autism

Consumer Watchdog filed a lawsuit Tuesday against the state agency that oversees HMOs, accusing it of violating state law by siding with insurance companies in denying treatment for children with autism. The suit accuses the department of changing its policies, forcing parents to appeal insurance denials through an internal grievance process rather than letting an independent panel of doctors make treatment decisions. "We want the department to follow the law. Doctors - not insurance companies and government lawyers - decide what care kids should get," said Jerry Flanagan, Consumer Watchdog's director of health policy.

Parents of Autistic Children Fight Back — Warn HMO Regulator Against Siding With Insurers Refusing to Pay for Treatment

Kaiser, Blue Cross and Other Health Insurers Illegally Deny Treatment to Autistic Children, Says Consumer Watchdog
 
Santa Monica, CA -- Parents of autistic children and their families joined Consumer Watchdog today in warning California regulators not to side with health insurance companies that are scheming to avoid paying for autism treatment that is required by state law.

WellPoint/Anthem Merger is a 9-figure Xmas Gift to Executives, Lump of Coal for Patients

The final approval today of the merger of HMO giants WellPoint Health Networks and Anthem Inc. by the Georgia insurance commissioner is "a 9-figure Christmas gift for company executives at a time when patients have to fight for basic health care coverage," according to Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights (FTCR).

CA Taxpayers Sue To Force Wellpoint/Blue Cross To Pay $500 Million In Unpaid Taxes

The Foundation for Taxpayer and Consumer Rights has filed a taxpayer lawsuit on behalf of all California taxpayers calling upon California Controller Steve Wesley and the Board of Equalization to collect hundreds of millions of dollars in gross premiums taxes unpaid by Wellpoint subsidiary Blue Cross of California during the last eight years.

Schwarzenegger Folds to Special Interests, OKs WellPoint/Anthem Merger; Garamendi Says “No” on Patients’ Behalf

Following the Schwarzenegger Administration's approval this morning of the pending buy-out of Blue Cross of California's parent company, WellPoint, by Anthem, the Foundation for Taxpayer and...

Open Letter to WellPoint and Anthem Shareholders Regarding Blue Cross of California’s Failure to Pay Gross Premium Tax

As California regulators review the impact on the California health care system of the proposed merger of Blue Cross of California's parent company, WellPoint Health Networks, and Anthem Inc,...

Patients, Taxpayers Criticize Anthem/WellPoint Merger Over Higher Premiums, Unpaid Taxes, Executive Compensation

At public hearings today on the buy-out of Blue Cross of California's parent-company, WellPoint Health Networks, by Anthem Inc., patients and taxpayers called on legislators and regulators to derail the deal and investigate Blue Cross' special tax status that has allowed the company to avoid paying about $500 million dollars in gross premium taxes since 1994.

Investigation of Blue Cross’ Tax Status Called for By Consumer Group

Blue Cross of California, whose parent company WellPoint has yet to receive approval for its pending merger with Anthem Inc., has avoided paying hundreds of millions of dollars in annual gross premium taxes

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