Therapies for Individuals with Developmental Disabilities Will Be Covered By Premera Blue Cross and LifeWise Health Plan of Washington

May 19, 2014, Seattle, WA – Premera Blue Cross and LifeWise Health Plan of Washington (LifeWise) have reached a final settlement agreement to resolve three class action lawsuits. The lawsuits were brought by five individuals diagnosed with autism. Plaintiffs in the lawsuits sought coverage of both neurodevelopmental therapies (speech, occupational and physical therapies) and applied behavior analysis (ABA) therapy to treat their autism under the Washington State Mental Health Parity Act. They also sought damages due to Premera’s alleged failure to cover the therapies in the past.

The settlement agreement was filed on May 16, 2014 in King County Superior Court with Judge Michael J. Trickey who presided over A.G. v. Premera Blue Cross, No. 11-2-30233-4 SEA, and will be filed today with Judge Julie Spector who presided over J.P. v. Premera Blue Cross, No. 12-2-33676-8 SEA and in federal district court in Seattle before Judge Richard A. Jones, R.H. v. Premera Blue Cross, No. 2:13-cv-00097-RAJ.

The Settlement Agreement provides for coverage of medically necessary neurodevelopmental therapy services to treat conditions listed in the DSM without application of Premera’s “developmental disability” exclusion, any age exclusion or treatment limitations. The Agreement also includes specific terms and conditions that memorialize how Premera will provide coverage for medically necessary ABA therapy to treat insureds with autism. The coverage changes in the Agreement apply to all insured plans issued by Premera and Lifewise in the State of Washington.

The Agreement also establishes a Settlement Fund of $3,500,000. This fund will reimburse class members for uncovered out-of-pocket expenses for neurodevelopmental therapy services.

Before the settlement can become effective, it must be preliminarily approved by all three judges in state and federal court. After that, final hearings on the settlement agreement will be scheduled in each court and a notice will be sent to all class members about the settlement, the final hearings, and the process for submitting claims for reimbursement of out-of-pocket neurodevelopmental therapy costs. If the final settlement agreement is approved, Class counsel estimates that the funds could be disbursed to affected families by the fall of 2014.

“Today is a proud day for our family,” said John Griffin, a parent of one of the plaintiffs. “Occupational and speech therapy made an enormous difference in our son’s life. As a result of the settlement, other children with developmental disabilities will now have full coverage for these services.”

“ABA therapy quite literally changed my then-teenage son’s life,” said Melissa Menti, of Bellingham, Washington, the parent of the plaintiff J.P., a 20 year old with autism. “ABA therapy helped my son to develop the behaviors he needs to live on his own and lead a productive and full life. I am so glad that other children will now have a clear way to obtain coverage of ABA.”

Eric Earling of Premera said, “there is a neurodevelopmental therapy mandate in Washington, which requires insurers to cover neurodevelopmental therapy for children under the age of 7 for group plans, Premera did that and more. For people with autism, Premera continued to cover neurodevelopmental therapy past the age of 7 and for members with individual plans. Premera is forgoing additional appeals in the interest of resolving the matter and moving forward for its members.”

More than a dozen class action lawsuits have been filed in Washington and Oregon over exclusions and limitations of neurodevelopmental and behavioral therapies in health insurance, Medicaid and employer-related health benefit plans.

“Some day soon all children in Washington State will have access to the speech, occupational, physical and ABA therapies that they need,” said Rick Spoonemore of Sirianni Youtz Spoonemore Hamburger. “This settlement agreement is a giant leap forward to that day. Premera should be commended for working with plaintiffs to ensure full coverage and better health care for Washington children.”

For More Information Contact:

Eleanor Hamburger or Rick Spoonemore,
Sirianni Youtz Spoonemore Hamburger: 206-223-0303