Federal Appeals Court Denies Blue Cross Blue Shield of Michigan's Petition to Appeal Ruling That Children With Autism May Challe


DETROIT, Feb. 24, 2012 /PRNewswire/ -- The Sixth Circuit Court of Appeals today denied a Petition by Blue Cross Blue Shield of Michigan which sought to overturn a ruling that all children who were denied Applied Behavior Analysis therapy for autism, on the ground that the therapy was "experimental," may sue as a class action. The ruling was issued in the case of Potter v Blue Cross Blue Shield of Michigan, No. 10-cv-14981 (E.D. Mich. 2011), pending in federal court in the Eastern District of Michigan, in Detroit.

Previously, on July 14, 2011, Judge Stephen J. Murphy, III, granted two families' Motion for Class Certification, ruling that Blue Cross' denial of this therapy presented a common issue appropriate for class action status. The court of appeals' denial today of Blue Cross' Petition to appeal means that the case will proceed on behalf of all families who were denied this critical therapy by Blue Cross, even those who never submitted a claim to Blue Cross in light of Blue Cross' well known policy to deny claims for ABA therapy.

ABA therapy is provided by prestigious health care providers all over the United States, including Beaumont Hospital's HOPE Center, and is approved by the American Academy of Pediatrics, the U.S. Surgeon General, the National Institutes of Health, and many others. In particular:

  • The U.S. Surgeon General states that "30 years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and increasing communication, learning and appropriate social behavior."
  • The National Institute of Mental Health concludes that, "among the many methods available for treatment and education of people with autism, applied behavior analysis (ABA) has become widely accepted as an effective treatment."
  • The National Institutes of Health concluded that the efficacy of ABA therapy is "significantly greater" than alternative interventions for children with autism and that behavioral treatment such as ABA therapy is an "effective" treatment for autistic children.
  • The Centers for Medicare & Medicaid Services concluded that "Applied behavior analysis (ABA) is an exception, in that controlled trials have shown both the efficacy of programs based in the principles of ABA . . . . As of the date of this report's publication, the only established evidence-based practice available is ABA."
  • The American Academy of Pediatrics and the National Research Council both emphatically recommend ABA-based interventions.

Despite the mountain of evidence showing that ABA therapy is well established and helps children with autism to achieve their greatest potential, Blue Cross continues to deny the therapy on the specious ground that it is "experimental." Yet, in mid-2010, Blue Cross settled the similar class action case of Johns v. Blue Cross, No.08-12272 (E.D. Michigan). In that case, Blue Cross agreed to reimburse nearly 100 families who were denied coverage for this therapy. Yet, after the settlement, Blue Cross persisted in denying this therapy to children with autism spectrum disorder. That led to the filing of another case against it, specifically, Potter v Blue Cross Blue Shield of Michigan.

The attorneys for the families are:

Gerard Mantese, Esq.
Mantese Honigman Rossman and Williamson, P.C.
1361 E. Big Beaver Road
Troy, Michigan 48083
248-457-9200 Office
248-515-6419 Cell

John J. Conway, Esq.
John J. Conway, P.C.
26622 Woodward Avenue, Suite 225
Royal Oak, MI 48067
313-961-6525 Office
313-574-2148 Cell

SOURCE Mantese Honigman Rossman and Williamson, P.C.