Insurance Commissioner Dave Jones Announces Settlement With UnitedHealthcare To Ensure Autism Coverage
News: 2012 Press Release
Insurance Commissioner Dave Jones today announced that he has reached another favorable agreement with an insurer, UnitedHealthcare Insurance Company, to require immediate coverage of behavioral therapy for autism as a medical benefit. This new agreement is the latest step in an industry wide compliance initiative by Commissioner Jones. It follows three settlements reached earlier this year with Blue Shield, Health Net and Cigna to provide behavioral health treatments, including Applied Behavior Analysis (ABA), a well-recognized and effective treatment for autism. In addition, Commissioner Jones reconfirmed that yet another major health insurer, Anthem Blue Cross of California, has been providing the coverage pursuant to Department of Insurance (CDI) direction since November 2009.
"We are pleased UnitedHealthcare joins four other insurers in fulfilling its responsibility to provide this necessary and vital treatment to the state's thousands of autistic children" said Commissioner Jones. "This new agreement means even more families affected by autism have hope for a brighter future, and this latest development could not have come at a better time with April being National Autism Awareness Month."
As part of the settlements, UnitedHealthcare also agreed to maintain an adequate provider network to enable the company to provide treatment to all policyholders with autism; provide services for the length of time, and at the number of hours per week specified by the insured's provider; and create a dedicated customer service unit with staff who are specially trained to handle inquiries about ABA, provide information about policy benefits for medically necessary behavioral health treatment, screening or diagnosis, verify coverage or eligibility and provide prior authorization, if required. Prior to this settlement UnitedHealthcare rejected claims for ABA, saying that the treatment was experimental and investigational.
This series of agreements ensures that the company complies with the state's Mental Health Parity Act (MHP), which requires coverage for medically necessary behavioral therapies. Reinforcing the requirement of the MHP, the Legislature last year passed SB 946 (Steinberg). Today's announced agreement supports the Commissioner's position that autism coverage was required before SB 946 and further demonstrates that Commissioner Jones will continue to require health insurers to provide coverage to those families and individuals seeking it.
To further help families living with autism CDI has added a special autism page to its Department Web site. The page offers information about services to help deal with the disorder, including: getting insurance coverage; going through the Independent Medical Review process; as well as a list of resources for family members; and a list of related organizations.
"The autism web page is an important tool the Department can offer to make the road a little smoother for California consumers dealing with autism," said Commissioner Jones.
The Order to Show Cause is available to the public.
The California Department of Insurance, established in 1868, is the largest consumer protection agency in California, regulating the $123 billion insurance marketplace. In 2013 the California Department of Insurance received more than 170,000 calls from consumers and helped recover over $63 million in claims and premiums. Please visit the Department of Insurance web site at www.insurance.ca.gov. Non-media inquiries should be directed to the Consumer Hotline at 800.927.HELP or 213.897.8921. Telecommunications Devices for the Deaf (TDD), please dial 800.482.4833.