Federal Appeals Court OKs Class Action Lawsuit for Families Denied Autism Therapy

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Last week, the Sixth Circuit Court of Appeals refused a petition from Blue Cross Blue Shield of Michigan that would have overturned an earlier ruling allowing families denied certain autism therapy coverage to push forward with a class action lawsuit.

Last November, a judge’s ruling in Potter v. Blue Cross Blue Shield of Michigan gave clearance to parents to sue the organization for rejecting Applied Behavior Analysis (ABA) as an insurable treatment, which Blue Cross deemed an “experimental” form of therapy.

The rejection of Blue Cross Blue Shield’s petition gives the go-ahead for two families to press forward with a class action suit, on behalf of all families denied therapy coverage by the organization.

The case is the second such class-action lawsuit brought against the organization in three years, following 2010’s Johns v. Blue Cross, a previous Michigan case in which the organization reimbursed almost 100 families that were denied Applied Behavior Analysis therapy coverage.

Despite Blue Cross’ claims that Applied Behavior Analysis is an unproven form of treatment, many organizations, including the National Institutes of Mental Health, the Centers for Medicare & Medicaid Services and the American Academy of Pediatrics, have all lauded the treatment as an effective form of therapy.

The U.S. Surgeon General has also recommended that treatment, stating that “30 years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and increasing communication, learning and appropriate social behavior.”

The outcome of Potter v. Blue Cross Blue Shield of Michigan is currently pending in a federal court in Detroit.

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