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What is the Current Status of the Blue Cross Class Action Lawsuit to Cover Autism Therapy?

March 1st, 2012

The 6th Circuit Court of Appeals has decided that a class action lawsuit against Blue Cross Blue Shield of Michigan can proceed. The large insurer is being sued because they denied coverage of Applied Behavior Analysis therapy, a therapy utilized by individuals with autism. The insurer deems this therapy “experimental or investigative,” whereas the plaintiffs assert that there is substantial scientific and medical evidence on the benefits of this therapy. The plaintiffs are two parents that have sons with autism who need this therapy that the insurer continues to deny.

Blue Cross tried to appeal the class action certification order in late February. The plaintiffs have filed their case under the Employee

Retirement Income Security Act of 1974 (ERISA) back in December 2010. Beyond the standard damages they are seeking, the plaintiffs want to ensure that future coverage for Applied Behavior Analysis therapy will be available for all those that were denied coverage by Blue Cross or did not seek out this type of therapy, but needed it, because of the insurer’s policy. The case seeks to include all persons affected after Dec. 16, 2004 in regards to this type of therapy.

A similar case back in 2009, Johns v. Blue Cross Blue Shield of Michigan, resulted in a settlement where Blue Cross reimbursed 100 families for this type of therapy.

What are the takeaways from the current Blue Cross class action lawsuit to cover autism therapy:

  • Circuit Court of Appeals has decided in favor of letting class action lawsuit proceed
  • Case will go back to the District Court Judge to read
  • Plaintiffs say Applied Behavior Analysis therapy is needed for children with autism and is supported by scientific and medical research whereas BCBS deems it “experimental”
  • Plaintiffs seek to have coverage for this type of therapy approved for future use by policyholders and be reimbursed for past expenses
  • Parents with questions about their BCBS coverage and therapies for special needs should contact an experienced special needs attorney to get access to benefits and services and learn more about the class action lawsuit.

Parents who are concerned about how this case could affect them should contact a special needs attorney. Individuals can learn about special needs planning and advocacy at

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