Lawsuit alleges state allows insurance companies to deny coverage for child autism treatments

A new lawsuit alleges that the California Department of Managed Health Care is violating state law by allowing health insurers to refuse payment for certain treatments for kids with autism. KPCC’s Brian Watt reports.

Brian Watt: The lawsuit focuses on a treatment approach known as Applied Behavioral Analysis. It involves intensive one-on-one interaction between a therapist and an autistic child for 30 or more hours a week. That makes it costly: $50,000 to $100,000 a year for each patient.

For years, insurance companies refused pay for this approach because they said it’s experimental. But medical experts and the US Surgeon General vouch for it now, and doctors like developmental pediatrician Anshu Batra usually recommend it for at least six months.

Dr. Anshu Batra: I have many families that are unable to access these therapies and I’m left basically unable to do my job.

Watt: Batra and the non-profit Consumer Watchdog filed the lawsuit.

Until a few months ago, when insurance companies denied a claim for the treatment, consumers could appeal through the managed health care department’s Independent Medical Review system. The team of independent doctors in that system increasingly sided with consumers.

The suit alleges that in March, after some lobbying from insurance companies, the department favored insurers and moved the review process for the treatments to an in-house staff. In a statement, the Department of Managed Health Care says it’s administering the consumer complaint process according to law.

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