Blue Shield retroactively covers autism treatment

Blue Shield of California has reached a deal with the California Department of Insurance to immediately cover the cost of an autism treatment called applied behavior analysis (ABA) therapy.

Per the agreement announced last Tuesday, Blue Shield will stop denying ABA therapy as a non-covered service, challenging its medical necessity or forcing parents to obtain approval from an independent medical reviewer before starting treatment, reported the Los Angeles Times. Blue Shield also will create a dedicated customer service unit that will respond to questions from families seeking ABA therapy.

"By taking this action, the Department of Insurance has put the entire health insurance industry in California on notice that denials of coverage for behavioral health treatment, including ABA therapy, must stop," said Commissioner David Jones. "Existing state law requires and has required health insurers to provide coverage for autism; we will continue to vigorously enforce that law and expect other health insurers to comply immediately."

The settlement is the result of an order Jones filed last July against Blue Shield. Jones sought Blue Shield's compliance with the state Mental Health Parity Act, which requires private insurance plans to provide equal coverage for mental health conditions, according to the Central Valley Business Times.

The California insurance department said the Blue Shield agreement demonstrates that insurers must provide retroactive coverage for ABA therapy and was required even before the state enacted legislation (S.B. 946) last October, LifeHealthPro reported.

Blue Shield said this agreement is similar to one reached last July with California's other insurance-regulatory agency, the Department of Managed Health Care.

To learn more:
- read the Los Angeles Times article
- check out the Central Valley Business Times article
- see the LifeHealthPro article
- read the Blue Shield order (.pdf)