Washington State Family Fights Insurer in Court

The Seattle Times reports:

Two Seattle lawyers have been quietly pushing to force insurers to cover therapy for autistic children.

Their latest success, against Premera Blue Cross and its subsidiary, LifeWise Health Plan of Washington, involves "A.G.," a 13-year-old Renton boy with autism.

This week, King County Superior Court Judge Michael Trickey ruled that the insurer's blanket exclusion for treatments of "developmental delay or neurodevelopmental disabilities" violates public policy as spelled out in Washington's Mental Health Parity Act.

Ele Hamburger and Richard E. Spoonemore of Sirianni Youtz Spoonemore have filed seven class-action lawsuits in state and federal courts against insurers, including Group Health Cooperative, Regence BlueShield and Molina Healthcare, and state programs such as Medicaid and the Uniform Medical Plan, which provides health coverage to public employees.

The lawsuits seek coverage for Applied Behavioral Assessment [sic] (ABA), a popular therapy for children with autism-spectrum disorder, as well as other behavioral and neurodevelopmental therapies, such as speech and physical therapy. Most of the lawsuits are still under way.

"We are looking to fundamentally alter the way health insurers in Washington cover therapy for autism" and other developmental disabilities, Spoonemore said.

The ruling is a preliminary injunction, applying only to A.G.'s case while the case is being litigated, Trickey said.

McClatchy reports that A.G. is Aidan Griffin, son of  John and Kathy Griffin:

For the last four years, Primera Blue Cross, the Griffin's health insurance company, has covered Aidan's speech and occupational therapy -- until now.

"Usually when you get your bill from the insurance company it's a regular-sized envelope. We got a giant envelope with a big stack of forms dated back to January 2010 saying we owed $24,000," John said..

KING-TV reports: