Settlement lifts Premera’s restrictions on autism therapy

May 19--Premera Blue Cross and its subsidiary, LifeWise Health Plan of Washington, will remove restrictions on neurodevelopmental therapy for autism and set aside $3.5 million to reimburse policyholders who paid for therapy out of pocket.

Under the settlement agreement, Premera and Lifewise will remove age limits and treatment limitations from any medically necessary speech, occupational and physical therapy. The change will apply to all insured plans issued by Premera and LifeWise in Washington.

The settlement is the latest to emerge from a string of lawsuits brought against insurers, employers and state agencies that restrict or limit neurodevelopmental therapy such as applied behavior analysis.

The final settlement agreement in the Premera case, reached in three class-action lawsuits in King County Superior Court and in U.S. District Court in Seattle, must be preliminarily approved by the three judges.

The lawsuits were brought by five individuals diagnosed with autism and their parents, alleging the restrictions violated the Washington State Mental Health Parity Act, which requires equal coverage for mental and physical services.

The settlement was agreed to after five days of negotiations with the aid of three mediators, according to court papers filed Friday in one of the King County cases.

Applied behavior analysis (ABA), one of the autism therapies, has been at issue in more than a dozen class-action lawsuits against insurers in Washington and Oregon.

The law firm in the current case, Sirianni Youtz Spoonemore Hamburger of Seattle, has brought most of those; a case against the state for Medicaid coverage was settled in 2012 by Northwest Justice Project, a statewide legal-aid project. All have settled in favor of plaintiffs.

Premera spokesman Eric Earling said in a statement that the insurer has previously gone beyond state requirements for neurodevelopmental therapy, which mandate therapy for children under age 7 for group plans. He said the company has covered children beyond age 7 and those in individual plans.

However, he said, "Premera is forgoing additional appeals in the interest of resolving the matter and moving forward for its members."

Melissa Menti, of Bellingham, the mother of a 20-year-old with autism who was a plaintiff in one of the lawsuits, said in a statement that ABA therapy changed her son's life when he was a teenager.

"ABA therapy helped my son to develop the behaviors he needs to live on his own and lead a productive and full life," Menti said. "I am so glad that other children will now have a clear way to obtain coverage of ABA."

Rick Spoonemore, one of the plaintiffs' lawyers, said in a statement he hoped all children would soon have access to the neurodevelopmental and behavioral therapies they need.

"This settlement agreement is a giant leap forward to that day," he said. "Premera should be commended for working with plaintiffs to ensure full coverage and better health care for Washington children."

Carol M. Ostrom: [email protected] or 206-464-2249. On Twitter @costrom

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