Public Employees Enrolled in the Uniform Medical PlanCan Receive Back Benefits For Applied Behavior Analysis Therapy

Final Settlement Provides for Reimbursement of Out-of-Pocket Costs for 
Behavioral Therapy for Autism

July 9, 2013, Seattle, WA – The Washington State Health Care Authority and a Class of Public Employee Benefits members with autism have reached a final settlement in a lawsuit seeking coverage of applied behavior analysis (ABA) therapy to treat autism and autism spectrum disorders under the state’s Uniform Medical Plan.  Notice to class members will be mailed this week.

The settlement was preliminarily approved by Judge Susan Craighead of King County Superior Court on June 28, 2013. The case is D.F. et al., v. Washington State Health Care Authority et al., No. 10-2-29400-7 SEA. A partial settlement requiring coverage of medically necessary ABA therapy to treat autism was reached in July 2012.  This final settlement creates a common fund of $3.5 million from which current and former enrollees in the Uniform Medical Plan can seek reimbursement for their out-of-pocket expenses for ABA therapy when used to treat autism from January 1, 2006 through December 31, 2012.

A final hearing on the settlement agreement is scheduled for September 5, 2013 at 9:00 am at Courtroom E-847, King County Superior Court in Seattle.  A notice will be sent to all class members about the settlement, the final hearing, and the process for submitting claims for reimbursement.  If the final settlement agreement is approved, Class counsel estimates that the funds could be disbursed to affected families by the fall of 2013.

“This settlement will enable hundreds of Washington families to obtain reimbursement for the ABA therapy that they provided for their children, since the Washington Mental Health Parity Act took effect,” said Arzu Forough, parent of two named plaintiffs and Chief Executive Officer of Washington Autism Alliance & Advocacy.  “Many families went into debt, liquidated their pensions, or gave up paying for other important basic needs, just to ensure that their children with autism received this essential therapy.  We hope that this fund will be an example for other insurers as to the right way to redress improper insurance company exclusions of ABA therapy.”

“I am pleased that the Health Care Authority was able to respond positively and make this important ABA benefit available to 200,000 Uniform Medical Plan members as well as 1.2 million Medicaid clients,” said Dorothy Teeter, Director of the Health Care Authority. “Thousands of Washington families dealing with autism will benefit from these changes.”

The Medicaid settlement is being handled separately by another court, which is awaiting federal approval of a State Plan Amendment on ABA therapy. The class action against HCA’s Uniform Medical Plan is actually one of seven pending class action lawsuits over Washington insurers’ limitations or exclusions, including lawsuits against Premera Blue Cross, Regence Blue Shield, and Group Health Cooperative.

“With this settlement, HCA establishes the path for resolving the ongoing litigation over health plans’ failure to provide mandated health coverage to persons with developmental disabilities,” said Rick Spoonemore of Sirianni Youtz Spoonemore Hamburger.  “We hope that other Washington insurers follow this path by establishing coverage for ABA therapy, clear criteria for obtaining such coverage, and a mechanism by which Washington insureds who needed ABA therapy but were not provided coverage can obtain reimbursement for those uncovered costs.”

For More Information Contact:

Dorothy Teeter, Director, HCA 360-725-1040

Eleanor Hamburger or Rick Spoonemore,

Sirianni Youtz Spoonemore Hamburger: 206-223-0303

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Without your time, commitment, and contributions WAAA would not succeed as an organization. It is only together that we can work towards our goal of improving outcomes for all who struggle with autism spectrum disorders.

Please support our inaugural fundraiser at The Makers in Seattle on July 27th, 2013.

Thank you for standing together with us for change.

Thankfully Yours,

Arzu Forough, CEO & Founder
Washington Autism Alliance and Advocacy