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A consumer group is suing California regulators for allowing health insurers to deny treatment for autism. Consumer Watchdog says thousands of children statewide are affected by the denials.
The autism treatment in question is called applied behavioral analysis. It’s a one-on-one therapy that helps children develop social and motor skills.
State regulators used to subject appeals of these denials to independent medical review. The lawsuit alleges reviews are now done by non-medical staff.
Jerry Flanagan is with Consumer Watchdog.
“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,” Flanagan says.
Regulators counter they’ve simply changed the way they interpret the law.
Flanagan says the law requires health plans to cover any necessary medical treatment.
Insurers say behavioral therapy isn’t medical.