A family here in Northern Virginia recently had to undergo a massive legal battle with Walmart over their health benefit plan. Walmart refused to pay for applied behavioral analysis therapy for the family’s autistic child, despite paying for it in the past and having the coverage outlined in their package. After a lawsuit was filed in federal court, Walmart agreed to pay the claim 100 percent, but not without pushing the family to sign a confidentiality agreement so that other families in need of autism therapy wouldn’t find out about Walmart’s autism policy. It took a lot of courage, but the family said “no” to the agreement so that their story could be told, even if that meant accepting less money from Walmart.

The lesson here is that you have to know your health insurance policy inside and out. Your employer or insurance provider is not always in your corner when talking to you about your policy, and denials of valid claims are rampant. This may have a devastating financial impact for those families caring for a family member who is on the autism spectrum. In this case, Walmart claims adjusters even mislead the family into not filing some claims until it was too late. I’m not a Walmart hater, in fact I have a good deal of respect for a lot of what they do as a business, but you have to honor your contracts.

This family fought the good fight so that you hopefully won’t have to. Know your policy so that you can’t get bullied in the future. Beginning in January 2013, Walmart decided to eliminate ABA therapy coverage from its health plan for its 1.4 million employees moving forward.

Ben Glass, Fairfax

Originally appeared in Fairfax times, Fairfax Virginia 

If medically necessary treatments for autism and related disorders are being denied or unreasonably capped, contact Washington Autism Alliance & Advocacy for pro-bono support for insurance appeals.