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Insurance Commissioner Dave Jones Announces Agreements with Major Health Insurers to Provide Autism Coverage

News: 2012 Press Release

For Release: February 27, 2012
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Insurance Commissioner Dave Jones Announces Agreements with Major Health Insurers to Provide Autism Coverage

Insurance Commissioner Dave Jones announced today that he has reached favorable settlement agreements with two major health insurers, Health Net and Cigna, to guarantee coverage of behavioral therapy for autism, and to provide it to all insureds whenever medically necessary.

The two new settlement agreements follow a similar settlement agreement reached last month with Blue Shield to provide behavioral health treatments, including Applied Behavior Analysis Therapy (ABA), a well-recognized and effective treatment for autism. In addition, Commissioner Jones reconfirmed that since November 2009 yet another major health insurer, Anthem Blue Cross of California, has been providing coverage of behavioral therapy for autism pursuant to Department of Insurance direction.  

"We are pleased that Health Net and Cigna now recognize their current obligations to provide crucial behavioral health treatment to the thousands of children who must live with autism every day," said Commissioner Jones. "And we are pleased to reconfirm and acknowledge Anthem Blue Cross of California for providing this treatment as the Department of Insurance has directed since November 2009. These agreements mean more families with autistic children won't have to lose sleep over whether or not they can afford a therapy that's been proven to transform lives."

As part of the settlements, Health Net and Cigna agreed to maintain an adequate provider network to enable them to provide treatment to all insureds with autism; not to reject any claims for ABA; and create dedicated customer service units or support teams specially trained to handle inquiries about ABA, requests for coverage or authorization, and for payment for ABA services. Prior to these settlements both insurers rejected claims for ABA. Anthem stopped denying coverage for ABA services in response to the Department of Insurance's direction in November, 2009, and since then has been offering ABA services as in network benefits to its insureds.

Jones pointed out that the agreements ensure that these companies comply with the state's Mental Health Parity Act (MHP), which requires coverage for medically necessary behavioral therapies. In keeping with the Act, the Department consistently has overturned health insurer denials of coverage for autism treatment. To further reinforce the requirements of the MHP, the Legislature last year passed SB 946 (Steinberg) which does not go into effect until July 1, 2012.

Today's announced agreements are consistent with the Commissioner's position that autism coverage was required before SB 946 and further demonstrate that Commissioner Jones will continue to require health insurers to provide such coverage to those families and individuals seeking it prior to the effective date of SB 946.

The settlements are available to the public.

Cigna's Stipulation and Order to Show Cause.
Health Net's Stipulation and Order to Show Cause.

Led by Insurance Commissioner Ricardo Lara, the California Department of Insurance is the consumer protection agency for the nation's largest insurance marketplace and safeguards all of the state’s consumers by fairly regulating the insurance industry. Under the Commissioner’s direction, the Department uses its authority to protect Californians from insurance rates that are excessive, inadequate, or unfairly discriminatory, oversee insurer solvency to pay claims, set standards for agents and broker licensing, perform market conduct reviews of insurance companies, resolve consumer complaints, and investigate and prosecute insurance fraud. Consumers are urged to call 1-800-927-4357 with any questions or contact us at via webform or online chat. Non-media inquiries should be directed to the Consumer Hotline at 800-927-4357. Teletypewriter (TTY), please dial 800-482-4833.

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