Accountability

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.

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

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

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.

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

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.

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.

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).
 

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 memo to insurers about autism treatment complaints

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.

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.

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 and HMO Execs

Los Angeles Superior Court BS 121397

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

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."

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.

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.

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.

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.

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.