Michigan's BCBS now covers ABA for autism therapy

May 14, 2009

Perhaps thanks to a lawsuit, some young children with autism may benefit from Blue Cross Blue Shield of Michigan's new initiative.

In the wake of a lawsuit against a health plan insurer pertaining limited coverage for autism therapies, young Michigan children with autism will be covered by Blue Cross Blue Shield of Michigan's new initiative to expand autism coverage, effective July 1.

The new optional benefit, available through group plans, is for children age 2 to 5 who have been prescribed applied behavioral analysis (ABA), an intensive early intervention. The benefit awaits official approval by Michigan's Office of Financial and Insurance Regulation.

The initiative follows a lawsuit filed by Christopher Johns, a Warren, Mich., father of a 7-year-old autistic son, against Blue Cross in US District Court in Detroit in May 2008. The suit was filed on behalf of those who have been denied claims related to ABA due to the treatment's experimental nature. Status of the case is pending.

Blue Cross officials contend that results of long-term studies on autism educational therapies have been inconclusive to date. And in Michigan, there is no mandate for experimental therapies such as this. However, a Blue Cross representative conceded during a deposition hearing filed May 11 that ABA was backed by the American Academy of Pediatrics. BCBSM announced its policy change the same day.

The benefit coverage would apply for no more than 60 treatment sessions, can be used once per child, and can be bought by groups, such as employers, that currently offer outpatient mental health coverage.