Group Sues Calif. Regulators Over Autism Care

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A consumer advocate group has sued California regulators accusing them of violating mental health and other laws by allowing health insurers to deny critical treatments for children with autism.

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.

"The essence of the suit is that doctors, not insurance company bureaucrats or government lawyers, should make decisions about what kind of care a child gets," said Jerry Flanagan, health care policy director for the consumer group. "This lawsuit is against state regulators for changing its practices and siding with insurance companies."

The lawsuit filed Tuesday in Los Angeles Superior Court accuses the department and its director Cindy Ehnes of changing the state agency’s policy to allow insurers to deny coverage for so-called applied behavioral analysis in violation of the California Mental Health Parity Act. The law requires health insurers to cover medically necessary treatments for autism.

For example, Flanagan said, insurers have denied coverage for so-called applied behavioral analysis, which can cost from $30,000 to $70,000 a year. Insurance companies have declined payment called the treatment experimental.

Department spokeswoman Lynne Randolph said the agency is following the law and "holding health plans accountable to provide a range of health care services for those with autism."

"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," she said.

Nearly one out of every 150 children born in the United States is diagnosed with autism, according to Consumer Watchdog. The condition hinders a person’s ability to communicate and interact with others.

Consumer Watchdog
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