The mental health parity act was enacted in 1999. It requires private insurance plans to provide equal coverage for selected mental health and physical conditions. The California Department of Insurance says Blue Shield is not following that law. Regulators ordered them to at a hearing in Sacramento.
Ioannis Kazanis says "It should be covered by insurers. So families of children with autism will have this opportunity to apply for this kind of therapy and have it covered by their health insurance providers."
Blue Shield of California says it's perplexed by the order and released a statement saying, "We will cover applied behavioral services for our members subject to appropriate consumer protections, as we seek guidance from the courts regarding what the law requires."
A settlement was also reached between the Department of Managed Health Care and Anthem Blue Cross regarding autism coverage.
A spokesperson says, "Anthem is putting into place procedures approved by the Department of Managed Health Care that would provide coverage in most situations for ABA services." A deal is also in the works with Kaiser Permanente.
The order is good news for Jessica Northrup. Jessica's son Salvador has autism. She says the order is a breakthrough for families like hers.
"It's a problem. I mean, I myself had problems just finding a pediatrician that would take my son on because he has autism," Northrup said.
Salvador is one out of 110 in California diagnosed with autism. Therapy can cost anywhere from $40,000 - $70,000 a year. The Alliance for California Autism Organizations says the state spends $320 Million on behavioral intervention services. It pays $80 Million on speech therapy. That's $400 Million a year.
Kristin Jacobsen adds, "I think the state can no longer afford to let the insurance companies collect the premiums and then have the state pay for health care services."
Only about 100 kids statewide currently have good coverage for autism therapy. First Five Fresno county says it's because their parents had to fight for it.
"This is a direct example of where policy will impact the services children so badly need," Fabiola Gonzales stated. "Especially in the valley, across the state."
The Department of Insurance issued the order Thursday. A hearing will now be scheduled to examine what the law requires. The state's Insurance Commissioner will make a decision on specifics of autism coverage after that.
TXT 24
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