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Anthem agrees to $1.6M settlement over autism therapy

April 10, 2018

Insurance company Anthem Inc. has agreed to pay more than $1.6 million to settle a federal lawsuit filed by Indiana parents who were denied coverage for therapy for their children with autism.

Two families sued Indianapolis-based Anthem after the company stopped covering their children's applied behavioral analysis, an intense and individualized therapy that focuses on improved communication, social skills and other behaviors.

In settling the lawsuit, Anthem agreed to stop using guidelines that base coverage for ABA therapy solely on an individual's age, The Indianapolis Star reported. Anthem and the plaintiffs said in a joint statement the resolution "ensures that Anthem members continue to receive the support they need."

The suit was brought by Chester and Kathryn Pierce, of Elkhart County, and Indianapolis residents Michael Beck and Joanne Kehoe.

The Pierce's suit, filed in 2015, sparked a campaign against Anthem's policy on Facebook and a rally on Monument Circle in front of Anthem’s corporate headquarters.

 In May 2012, Anthem sent a letter to families with autistic children stating that it would no longer pay for therapy for school-age children during the time they are or could be in a public school. Anthem claimed the federal Individuals with Disabilities Education Act requires public schools to provide services to autistic children via individualized education programs, known as IEPs.

“Anthem cannot duplicate coverage for services that are available through the public school system,” Anthem stated in the letter to parents.

The insurer had physicians with specialties in psychiatry—but not necessarily autism—review therapists’ treatment plans for each patient. Anthem never issued a complete denial of coverage. But for school-age children, it often reduced the number of treatment hours for which it would pay from the amount requested by therapists.

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