Search This Blog

Tuesday, February 28, 2012

An Insurance Settlement in California

A release from the California Department of Insurance:
Insurance Commissioner Dave Jones announced today that he has reached favorable settlement agreements with two major health insurers, Health Net and Cigna, to guarantee coverage of behavioral therapy for autism, and to provide it to all insureds whenever medically necessary.
The two new settlement agreements follow a similar settlement agreement reached last month with Blue Shield to provide behavioral health treatments, including Applied Behavior Analysis Therapy (ABA), a well-recognized and effective treatment for autism. In addition, Commissioner Jones reconfirmed that since November 2009 yet another major health insurer, Anthem Blue Cross of California, has been providing coverage of behavioral therapy for autism pursuant to Department of Insurance direction.

...As part of the settlements, Health Net and Cigna agreed to maintain an adequate provider network to enable them to provide treatment to all insureds with autism; not to reject any claims for ABA; and create dedicated customer service units or support teams specially trained to handle inquiries about ABA, requests for coverage or authorization, and for payment for ABA services. Prior to these settlements both insurers rejected claims for ABA. Anthem stopped denying coverage for ABA services in response to the Department of Insurance's direction in November, 2009, and since then has been offering ABA services as in network benefits to its insureds.