California payers delay compliance with autism coverage requirements

Payers in California are dragging their feet and delaying compliance with state law requiring they cover behavioral therapy for members with autism, the state insurance department said Thursday.

That's why Insurance Commissioner Dave Jones released an emergency regulation aimed at insurers who have been delaying compliance and denying claims for applied behavior analysis and other autism therapies. The regulation demands that insurers stop stalling and immediately provide coverage for children with autism, the Central Valley Business Journal reported.

"Behavioral therapy is a medical treatment and has to be covered," Jones told the Los Angeles Times.

In the seven months since the legislation (S.B. 946) was enacted, the insurance department has received 71 complaints from consumers trying to obtain coverage for autism therapies. And about 1,600 consumers transitioning from regional centers to insurers for behavioral health treatment have experienced delays and denials, according to a department statement.

These delays, according to the department, can cause such severe consequences as immediate regression, stifled improvement, severe impairment and even permanent developmental damage.

"Many insurers are failing to comply with California law that mandates medically necessary treatment," Jones said. "This regulation will clarify insurers' obligations to provide these critical services."

To learn more:
- here's the California insurance department statement
- read the Los Angeles Times article
- check out the Central Valley Business Journal article

AHIP WEBINAR

Fuel Top Line Growth and Increase Membership

In this webinar, payers can learn how to accelerate the sales pipeline and grow membership across all health insurance market segments using comprehensive sales technologies.