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Sunday, November 16, 2014

Insurance in Washington State

Autism Speaks reported yesterday:
Autism Speaks welcomed Washington as the 38th state to enact autism insurance reform during the 6th annual Autism Law Summit held here today. Washington became the first state to require private insurers to cover medically necessary treatment of autism through litigation; the previous 37 states enacted specific insurance reform laws.
The Washington Autism Alliance & Advocacy (WAAA) teamed up with Seattle attorney Eleanor Hamburger in pursuing a series of successful state and federal class action lawsuits against Washington's major insurance carriers as well as the state employees health benefit plan.
WAAA Founder Arzu Forough [left] and staff attorney Mira Posner celebrate in Nashville
The most recent case, OST v Regence, led to a unanimous state Supreme Court ruling directing Regence Blue Shield, the state's largest private insurer to stop enforcing blanket exclusions for medically necessary mental health coverage, such as applied behavior analysis (ABA) for autism. Hamburger within days then announced she had reached a settlement with Regence of state and federal class action suits.
The proposed settlement would require coverage for medically necessary speech, occupational and physical therapies and ABA therapy to treat mental health conditions, including autism. Exclusions, age limits, monetary caps and visit limits would all be prohibited. A $6 million settlement fund would be established by Regence to reimburse policyholders whose previous claims for autism coverage were denied.
The Supreme Court decision then prompted state Insurance Commissioner Mike Kreidler to direct all state-regulated private health plans to provide coverage in 2015 and to reconsider all claims denied since 2006 on the basis of a blanket exclusion. The order also covers new health plans sold through Washington Healthplanfinder, the state's Marketplace created under the Affordable Care Act.
The state and federal class actions were all brought on the basis that the blanket exclusions violate state and federal mental health parity law.