Insurer to Pay $1.6M to Settle Indiana Suit Over Autism Therapy

An insurance company 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 Anthem in 2016 after the company stopped covering applied behavioral analysis therapy for their children meant to improve communication, social skills and other behaviors, The Indianapolis Star reported.

The suit was brought by Indiana residents Chester and Kathryn Pierce, and Michael Beck and Joanne Kehoe.

The Pierces sought 40 hours a week of ABA therapy for their then 14-year-old son who has severe autism, court records said. Anthem denied the request for 40 hours of intense and individualized therapy and reduced the numbers of hours to 25 in 2013. The company then reduced the number to 20 hours one year later.

Anthem also denied Beck and Kehoe in October 2013 the 40 hours per week of therapy they requested for their then 11-year-old son, the lawsuit said. Anthem reduced the number of hours to 30, and then dropped it down to 20 hours a few months later.

Anthem said some therapy services could be done through school, court records said.

Anthem denied the lawsuit’s allegations but agreed to settle the case.

The insurance company agreed in the settlement to stop using guidelines that base coverage for ABA therapy solely on an individual’s age.

The resolution “ensures that Anthem members continue to receive the support they need,” Anthen and the plaintiffs said in a joint statement.

About 200 children who Anthem denied ABA therapy coverage to from 2012 to 2017 may receive payment if the settlement is approved in court, according to The Arc of Indiana, an advocacy group for people with developmental disabilities.