Insurance chief settles with Blue Shield over autism therapy

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

California Insurance Commissioner Dave Jones on Tuesday announced that Blue Shield of California Life and 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 stems from a dispute that began last 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 released by his office.


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 with Jones is similar to one made with the California Department of Managed Healthcare last July, said Tom Epstein, Blue Shield’s vice president for communications.

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

Jones’ settlement clarifies that existing state law mandated autism therapy treatment in the past. Meanwhile, a new state law that takes effect in July reiterates that coverage cannot be denied in the future under the California Mental Health Parity Act.



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