Blue Shield agrees to cover autism therapy


A major health insurance company has settled an enforcement action with state regulators over providing special therapy for autism patients.

California Insurance Commissioner Dave Jones on Tuesday said that Blue Shield of California Life & Health Insurance Co. agreed to immediately cover the cost of applied behavior analysis therapy, which Jones described as a well-recognized and effective treatment.

The settlement with the Insurance Department stems from a dispute that began in July when Jones filed an enforcement action against Blue Shield.


“This favorable settlement agreement eliminates the frustration and insecurity so many families have faced when seeking autism treatment for their children,” Jones said in a statement.

Blue Shield no longer will deny the therapy as a non-covered service, challenge its medical necessity or force parents to get approval from an independent medical reviewer before starting treatment, Jones said.

The agreement is similar to one made with the California Department of Managed Health Care in July, said Tom Epstein, Blue Shield’s vice president for communications. In fact, Blue Shield in July began paying for the therapy for members enrolled in plans regulated by the Insurance Department, he said.

Blue Shield was the first insurer to agree to cover such services for members with autism, Epstein said.

Jones’ settlement resolves any lingering legal disputes for current and past claims.

Meanwhile, recently approved legislation, which takes effect in July, makes it clear that applied behavioral analysis therapy must be made available for any member of Blue Shield or any other healthcare provider in California.


“The settlement today confirms that autism coverage was required before” the new law was passed, the Insurance Department said, “and 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 the new law, SB 946.