U.S. District Court Eastern District: Autism treatment coverage should have been provided

By Douglas Levy Dolan Media Newswires DETROIT, MI -- Blue Cross Blue Shield of Michigan acted illegally in denying coverage for Applied Behavior Analysis therapy to children with autism spectrum disorder, according to a federal district court ruling. In Potter, et al. v. Blue Cross Blue Shield of Michigan, Case No. 10-14981, U.S. Eastern District Judge Stephen Murphy III noted that ABA therapy is supported by numerous authorities, and is not supported by Blue Cross' own medical policy Murphy held that Blue Cross' denial of insurance coverage for this therapy on the grounds that the therapy is "experimental" was arbitrary and capricious under federal law. Blues Cross' policy "is internally inconsistent, ambiguous, and, most fatally, not supported by the evidence in the record," he wrote. Blue Cross had attempted to overturn the court's initial class certification ruling in the 6th Circuit Court of Appeals, but the court denied the petition. In a statement, plaintiffs' attorneys Gerard Mantese and John Conway said this ruling is expected to benefit more than 500 children with autism spectrum disorder, and result in more than $5 million in ABA therapy benefits being paid to class members. Published: Mon, Apr 8, 2013

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