Washington Insurer to Cover Developmental Disabilities

Seattle, WARegence BlueShield will settle two Washington insurance lawsuits and has agreed to cover neurodevelopmental disability therapies, according to reports. This makes the insurance company the third of the three largest to face insurance lawsuits concerning neurodevelopmental disability therapy. The settlement, which was announced following a state Supreme Court Decision, will affect policyholders and their dependents who require autism treatments.

According to Autism Speaks (10/17/14), Regence BlueShield is the largest Washington State health insurer. The company has now agreed to settle two class-action lawsuits by including coverage for medically necessary speech, occupational and physical therapies. Regence BlueShield will also include ABA therapy. All coverage will be offered without exclusions, age limits or monetary caps. A fund of $6 million will also be set aside to reimburse policyholders who previously had their claims for coverage of autism therapy denied.

A lower court had ruled against Regence, ordering the company to provide coverage for occupational therapy and speech therapy. That court found in favor of the plaintiffs and ruled that the language in the insurance contract excluding neurodevelopmental therapy from coverage did not comply with state law.

According to KUOW (6/13/14), Washington law does not require insurance carriers to cover autism treatments. But plaintiffs argued that Washington’s Mental Health Parity Act does require coverage. Laws covering neurodevelopmental therapy only applied to employer-based health plans and only covered children up to age 6. Those who had insurance that was not employer-based or who had children over age 6 were not eligible.

Earlier in October, the Washington Supreme Court found that health insurers must cover medically necessary developmental therapies. Regence BlueShield claimed Washington’s Mental Health Parity Act did not require coverage of neurodevelopmental therapies, including physical, occupational and speech therapy.

In issuing their ruling, judges in the Supreme Court of the State of Washington wrote, “We hold the neurodevelopmental therapies mandate and the mental health parity act do not conflict. The mental health parity act requires insurers to provide NDT coverage in individual plans when the therapies are medically necessary to treat mental disorders recognized in the DSM-IV-TR if the insurance contract covers medical and surgical services.” The judges later wrote that insurers are required to meet the guidelines set out in both the neurodevelopmental therapies mandate and the mental health parity act and found Regence BlueShield’s arguments “unpersuasive.”

The lawsuit was O.S.T. et al. v. Regence BlueShield, No. 88940-6. In the Supreme Court of the State of Washington.