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Rick Spoonemore, 206-223-0303

Sirianni Youtz Spoonemore

Group Health Cooperative to Offer Special Autism Benefit in Washington State

Court settlement would extend autism coverage to include applied behavioral analysis (ABA) therapy

SEATTLE  – Group Health Cooperative and Sirianni Youtz Spoonemore, counsel for a class of Group Health enrollees with autism, have filed a proposed settlement agreement in D.M. v. Group Health Cooperative, No. 10-2-28618-7 SEA (King County Superior Court, Judge Beth Andrus), which, if approved by the court, will establish coverage for applied behavior analysis (ABA) therapy to treat autism and autism spectrum disorders.  The proposed settlement agreement applies to Group Health members diagnosed with autism or an autism spectrum disorder who are insured under a Group Health plan not governed by the Employee Retirement Income Security Act (“ERISA”).  Non-ERISA plans include church, tribal, and state and local government plans.

“The court process is moving us toward a determination of appropriate coverage following the passage of the mental health parity laws at the state level,” said Scott Armstrong, Group Health president and CEO.  “We are pleased to be taking this step toward resolving issues associated with coverage certain therapies for patients with autism.”

Group Health was one of the first health plans in the nation to offer mental health benefits to its members in the 1960s. Group Health publicly supported the passage of Washington’s Mental Health Parity Act in 2005.

Group Health will provide coverage for ABA therapy for certain plan members to treat autism and autism spectrum disorders.  The ABA coverage will be provided pursuant to specific coverage criteria and will include providing therapy in settings such as a child’s home, by therapy assistants working under the supervision of licensed providers.  Class members may contact Group Health customer service to find out more.

“We are very pleased to work with Group Health to make ABA therapy available to children with autism, like our son,” said John Morton, D.M.’s father.  “We have seen remarkable improvement in our son since he started ABA therapy,” said Clara Chan, D.M.’s mother.  “This agreement paves the way for many children with autism to have access to this essential therapy.”

“We commend Group Health for stepping forward to be the first insurer to provide this benefit,” said Rick Spoonemore of Sirianni Youtz Spoonemore.  “We believe this agreement sets the standard for coverage of ABA therapy by which all other insurers will be judged.”

The class action against Group Health is one of six pending class action lawsuits against Washington insurers brought by Sirianni Youtz Spoonemore on behalf of developmentally disabled insureds challenging  exclusions of neurodevelopmental and behavioral therapies. 

Group Health is one of the nation’s leading nonprofit health systems, recognized for its consumer-governed cooperative origins and innovative solutions for improving care. Established in 1947, Group Health Cooperative, together with its subsidiaries Health Options, Inc. and KPS Health Plans, provides health coverage to more than 664,000 residents of Washington state and North Idaho.

More than 420,000 members receive care from Group Health Physicians medical group at Group Health Medical Centers locations across the Puget Sound region and Spokane. Group Health advances health in the community through its medical education, charitable foundation, and nationally recognized research institute.

Sirianni Youtz Spoonemore

Sirianni Youtz Spoonemore is a Seattle law firm specializing in individual and class action ERISA, health, pension, and disability litigation as well as general commercial litigation.

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