Judge: Insurer wrong to deny autism coverage

Published on NewsOK Modified: April 3, 2013 at 6:15 am •  Published: April 3, 2013

DETROIT (AP) — A federal judge has ruled that Blue Cross Blue Shield of Michigan was wrong to deny coverage for certain autism treatment services.

The Detroit-based insurer rejected claims for applied behavior analysis, saying the treatment was investigative or experimental. Judge Stephen J. Murphy III ruled last week that the basis for denial was "arbitrary and capricious" and sent the claims back for reconsideration.

MLive.com reports (http://bit.ly/10pGCft ) the ruling could impact about 500 families who had to pay for coverage out of pocket since 2010. Lawyer Gerard Mantese, who represented parents of children with autism in the lawsuit, estimated payments could total $5 million.

Blue Cross could appeal. Spokeswoman Helen Stojic said in a statement they "understand the concern and are very sympathetic to the challenges of families dealing with autism."

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