The Oregon Insurance Division issued a landmark order Friday requiring commercial health insurers to cover an innovative, but expensive, type of autism therapy.
Activist families have been fighting the insurance industry for years over coverage of so-called applied behavior analysis (ABA) therapy, a sometimes highly effective treatment for a malady once thought incurable. Families have won a series of high-profile legal and regulatory victories of late to force coverage.
Many of the state's largest health insurers have denied coverage, leaving families to bear the $30,000-$50,000 annual cost by themselves.
The division issued two so-called bulletins. The second is a broader ruling requiring insurers to determine coverage of mental health and chemical dependency conditions in the same manner they do for physical medical conditions.
Some insurers continued to refuse claims from families seeking coverage for ABA therapy even in late September and early October, six weeks after the insurance division issued its draft language putting the industry on notice.
Moda Health rejected at least two Oregon families and Regence Blue Cross Blue Shield rejected at least one on grounds ABA was still an "investigational" or "educational" treatment, documents show.