Blue Cross Blue Shield of Michigan will reimburse policy holders who paid out of pocket for behavioral therapy for children with autism dating back to May 1, 2003 under a legal settlement reached this week.

The move comes in the case of Christopher Johns who filed suit earlier this year after Blue Cross denied claims for applied behavioral analysis (ABA) for his son who has autism because the insurer said the treatment is experimental. Already in May Blue Cross announced that it would begin covering ABA therapy effective July 1.

The settlement will provide payment to the families of more than 100 children who paid for behavioral therapy over the last six years while they were insured by Blue Cross. Families are eligible for payment even if they didn’t submit a claim with the insurer.

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“No insurer should ever take this approach to needed care for children. Applied behavioral analysis therapy is supported by science and is not ‘experimental,'” Johns’ attorneys, Gerard Mantese and John J. Conway, said in a statement. “Research shows that children with autism spectrum disorder need this therapy early on in life and delaying treatment can irreversibly prevent them from achieving their full potential.”

The attorneys indicate this may be the first such settlement reached nationwide regarding ABA therapy.


Previous stories on this topic:

Under Threat Of Lawsuit, Insurer Says It Will Cover Autism Behavior Therapy (May 11, 2009)

Judge Tells Insurer To Prove Behavior Therapy Is Experimental (March 9, 2009)

Judge Considers Suit Against Blue Cross Over Autism Treatment (February 26, 2009)

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