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Denied Claims Blog

Families of Autistic Children Win Court Battle Against Blue Cross Blue Shield

April 3, 2013

The autism community won a battle against Blue Cross Blue Shield of Michigan on March 30 when a federal court in Detroit held that the denial of claims for Applied Behavior Analysis therapy was illegal.

The ruling came as a huge relief to the parents of autistic children. Advanced Behavior Analysis (ABA) therapy is a widely used and medically accepted treatment for autism. The U.S. Surgeon General, the National Institutes of Health, the American Academy of Pediatrics and the Medicare and Medicaid programs all agree that the evidence has shown ABA therapy to be effective.

Blue Cross Blue Shield, however, insisted on classifying the therapy as “experimental” and refused coverage to children with autism, according to a press release from the law firm that successfully challenged the insurer.

Denied Claims Caused Irreparable Damage to Children

Not only is ABA therapy medically and scientifically accepted, but it is also known to be time-sensitive. The earlier that intervention begins, the better the outcome for the child. The time lost when a claim is denied chips away at the child’s chances for a full and independent life.

The families of children with autism who were denied coverage thus had to decide whether to proceed with the therapy despite the financial cost or forgo therapy. That is a decision no family should ever have to make.

Blue Cross Blue Shield Must Pay Claims

Filed in 2004, the case against Blue Cross Blue Shield officially became a class action suit in 2012. All families who were denied ABA therapy will now finally receive the ABA benefits they were due in the first place. Over $5 million in ABA therapy benefits will be paid to claim members. Moving forward, the company can no longer deny claims for this life-changing treatment. Over 500 children with autism will benefit from the ruling.

Your Insurance Company May Not Be Looking Out For You

Your insurance carrier is concerned with profit, not health. Even when children’s lives are at stake, if they can get away with denying a claim, they will. The insurance world is a spiderweb of bureaucracy designed to discourage people from fighting for their rightful coverage. But you do have rights. Contact us if your insurance company had denied a claim that should have been covered.

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