Blues plan to cover autism therapies for children 2-5

Detroit News  |  May 12, 2009

Blues plan to cover autism therapies for children 2-5

Jennifer Chambers / The Detroit News

Detroit -- Blue Cross Blue Shield of Michigan announced Monday it plans to offer coverage beginning July 1 for autism therapies that provide intensive early intervention.

The new benefit option covers children 2 to 5 years old who use a treatment called applied behavioral analysis.

The new benefit option, to be offered through group plans, is subject to approval by the state Office of Financial and Insurance Regulation.

"We saw a need in the community and moved to find a way to address it," said Dr. Thomas Simmer, Blues senior vice president and chief medical officer.

The insurer is being sued for refusing to cover certain autism therapies.

Christopher Johns, a Warren father whose 7-year-old son is autistic, is suing Blue Cross in U.S. District Court in Detroit on behalf of people who have been denied claims on the basis that applied behavioral analysis treatment for their autistic child is experimental.

Johns filed the suit in federal court in May 2008 and is seeking class action status because more than 7,000 children in Michigan have autism, a neurological disorder that can cause them to become withdrawn and nonverbal and avoid eye contact. The case is pending.

Data from the federal government show that 1 in 150 American children have the disorder.

Blue Cross officials maintain that long-term studies on autism educational therapies have been inconclusive and the treatments are experimental. Michigan law doesn't mandate coverage for such therapies.

"We are pleased that the pressure of our federal court lawsuit has caused Blue Cross to begin doing the right thing, and we are confident that our litigation will cause Blue Cross to provide other relief and benefits to those children with autism," said Johns' attorney, Gerard Mantese.

The benefit coverage, which consists of up to 60 treatment sessions, can be used once per child, and will be available for purchase by groups -- such as employers -- that already have outpatient mental health coverage.

Michigan lawmakers are trying to get bills passed that would mandate insurance coverage for autism.

jchambers@detnews.com (248) 647-7402