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My question as a parent is since this was achieved with a private insurance company would there be any cases regarding medicaid covering the ABA ?
TIA
MG
In a message dated 6/20/2009 7:49:15 P.M. Central Daylight Time, opengaautism@yahoogroups.com writes:
Messages In This Digest (3 Messages)
- 1a.
- Blue Cross Blue Shield of Michigan Forced to Pay for Autism Care In From: Robert W. Montgomery, Ph.D., BCBA
- 1b.
- Re: Blue Cross Blue Shield of Michigan Forced to Pay for Autism Car From: Robert W. Montgomery, Ph.D., BCBA
- 1c.
- Re: Blue Cross Blue Shield of Michigan Forced to Pay for Autism Car From: Mindy Smith-Pace
Messages
- 1a.
Blue Cross Blue Shield of Michigan Forced to Pay for Autism Care In
Posted by: "Robert W. Montgomery, Ph.D., BCBA" rwmontgomery@... docrwm1
Sat Jun 20, 2009 6:11 am (PDT)
Blue Cross Blue Shield of Michigan Forced to Pay for Autism Care In Landmark Case
Release issued by Mantese and Rossman, P.C., on June 19, 2009
Detroit, Michigan. The family of an autistic child filed a motion in
federal court today to confirm settlement of a class action against
Blue Cross Blue Shield of Michigan. The family alleged in the suit
that the insurer wrongfully refused to cover behavioral therapy for
children with autism spectrum disorder (ASD), on the baseless ground
that the care was "experimental."
Under the terms of the settlement reached at a court-ordered conference
on Wednesday, June 17, 2009, Blue Cross has agreed to reimburse all
families who paid for behavioral therapy for their children after May 1,
2003, and who were covered under a Blue Cross Blue Shield of Michigan
insurance policy. Blue Cross had earlier filed a motion seeking
dismissal of virtually the entire case on legal grounds, but the
Honorable Stephen J. Murphy III permitted the case to go forward and
scheduled the matter for further proceedings, including a settlement
conference before Magistrate Michael Hluchaniuk.
The settlement was reached in the case of Christopher Johns v. Blue
Cross Blue Shield of Michigan, 08-cv-12272, filed in Detroit. In the
suit, the plaintiff alleged that Blue Cross' pattern and practice of
characterizing the scientifically established Applied Behavioral Therapy
as "experimental," and thus as excluded under its insurance policies,
was arbitrary, capricious, illegal and contradicted by many years of
scientific validation.
Under the settlement, Blue Cross will pay for behavioral therapy
rendered to over 100 children in the last six years. Plaintiff's
counsel, Gerard Mantese and John J. Conway, were pleased with the
settlement. Mr. Mantese and Mr. Conway issued a joint statement
emphasizing: "No insurer should ever take this approach to needed care
for children. Applied Behavioral Analysis therapy is supported by
science and is not 'experimental.' Delays by insurers in authorizing
this treatment, when it is covered by insurance policies, should not be
tolerated. Research shows that children with autism spectrum disorder
need this therapy early on in life and delaying treatment can
irreversibly prevent them from achieving their full potential."
Mr. Mantese emphasized that the settlement includes even families who
never submitted a claim to Blue Cross, but who obtained this care for
their children and were covered by a Blue Cross policy. Mr. Conway
believes that this is the first such settlement addressing Applied
Behavioral Analysis (ABA) in the country.
ABA therapy is administered under the supervision of licensed
psychologists and other professionals. ABA applies one hundred year old
concepts of changing behavior through positive and negative
reinforcements. The federal suit in which this settlement was achieved
centered upon the ABA treatment provided by prestigious Beaumont
Hospital and its HOPE Center, including Dr. Ruth Anan and Dr. Lori
Warner.
The case settled shortly after Plaintiff's counsel obtained a court
order requiring Blue Cross to produce file documents which validated the
effectiveness of ABA therapy for treating children with autism spectrum
disorder. Among the documents in the Blue Cross files obtained by
Plaintiff's counsel was a draft of a Blue Cross Blue Shield Medical
Policy for 2005, which acknowledged the following:
Applied behavioral analysis (ABA) is
currently the most thoroughly researched treatment modality for early
intervention approaches to autism spectrum disorders and is the standard
of care recommended by the American Academy of Pediatrics, National
Academy of Sciences Committee and the Association for Science in Autism
Treatment, among others.
Blue Cross' own documents further acknowledged that:
The earlier the disorder is diagnosed,
the sooner the child can be helped through treatment interventions.
Mr. Mantese stated, "After we compelled Blue Cross through motion
practice to produce all materials supporting its position that this care
was allegedly experimental, we received numerous file documents which
actually established that ABA therapy works and is highly effective in
increasing the functioning of these children."
Mr. Conway emphasized, "We are pleased that we were able to obtain a
result which will require Blue Cross to pay for this important care and
will alleviate some of the financial strain imposed on over a hundred
families by having to pay for this care when it was covered under their
insurance policies."
Contact information for the families' attorneys follows:
Gerard Mantese, Esq.
Mantese and Rossman, P.C.
1361 E. Big Beaver Road
Troy, Michigan 48083
248-457-9200 Office
248-515-6419 Cell
John J. Conway, Esq.
John J. Conway, P.C.
645 Griswold St, Ste 3600
Detroit, MI 48226
313-961-6525 Office
313-574-2148 Cell- 1b.
Re: Blue Cross Blue Shield of Michigan Forced to Pay for Autism Car
Posted by: "Robert W. Montgomery, Ph.D., BCBA" rwmontgomery@... docrwm1
Sat Jun 20, 2009 6:14 am (PDT)
Sorry, somehow my comments at the beginning of the article did not make it into the post.
While this is Michigan it does relate to BCBS. BCBS issued a 123
page document earlier this Spring again declaring ABA Experimental.
Funny, the "experts" that wrote the document did not have the spine
to attach their names to it. This case illustrates why. The actual
data clearly says just the opposite, even when it comes from BCBS's
own files!
If anyone has BCBS Coverage and it is OUT OF MICHIGAN this may be
very important for you. Hope it helps someone.
--- In opengaautism@yahoogroups. , "Robert W. Montgomery, Ph.D., BCBA" <rwmontgomery@com ...> wrote:
>
> Blue Cross Blue Shield of Michigan Forced to Pay for Autism Care In Landmark Case
>
> Release issued by Mantese and Rossman, P.C., on June 19, 2009
>
> Detroit, Michigan. The family of an autistic child filed a motion in
> federal court today to confirm settlement of a class action against
> Blue Cross Blue Shield of Michigan. The family alleged in the suit
> that the insurer wrongfully refused to cover behavioral therapy for
> children with autism spectrum disorder (ASD), on the baseless ground
> that the care was "experimental."
>
> Under the terms of the settlement reached at a court-ordered conference
> on Wednesday, June 17, 2009, Blue Cross has agreed to reimburse all
> families who paid for behavioral therapy for their children after May 1,
> 2003, and who were covered under a Blue Cross Blue Shield of Michigan
> insurance policy. Blue Cross had earlier filed a motion seeking
> dismissal of virtually the entire case on legal grounds, but the
> Honorable Stephen J. Murphy III permitted the case to go forward and
> scheduled the matter for further proceedings, including a settlement
> conference before Magistrate Michael Hluchaniuk.
>
> The settlement was reached in the case of Christopher Johns v. Blue
> Cross Blue Shield of Michigan, 08-cv-12272, filed in Detroit. In the
> suit, the plaintiff alleged that Blue Cross' pattern and practice of
> characterizing the scientifically established Applied Behavioral Therapy
> as "experimental," and thus as excluded under its insurance policies,
> was arbitrary, capricious, illegal and contradicted by many years of
> scientific validation.
>
> Under the settlement, Blue Cross will pay for behavioral therapy
> rendered to over 100 children in the last six years. Plaintiff's
> counsel, Gerard Mantese and John J. Conway, were pleased with the
> settlement. Mr. Mantese and Mr. Conway issued a joint statement
> emphasizing: "No insurer should ever take this approach to needed care
> for children. Applied Behavioral Analysis therapy is supported by
> science and is not 'experimental.' Delays by insurers in authorizing
> this treatment, when it is covered by insurance policies, should not be
> tolerated. Research shows that children with autism spectrum disorder
> need this therapy early on in life and delaying treatment can
> irreversibly prevent them from achieving their full potential."
>
> Mr. Mantese emphasized that the settlement includes even families who
> never submitted a claim to Blue Cross, but who obtained this care for
> their children and were covered by a Blue Cross policy. Mr. Conway
> believes that this is the first such settlement addressing Applied
> Behavioral Analysis (ABA) in the country.
>
> ABA therapy is administered under the supervision of licensed
> psychologists and other professionals. ABA applies one hundred year old
> concepts of changing behavior through positive and negative
> reinforcements. The federal suit in which this settlement was achieved
> centered upon the ABA treatment provided by prestigious Beaumont
> Hospital and its HOPE Center, including Dr. Ruth Anan and Dr. Lori
> Warner.
>
> The case settled shortly after Plaintiff's counsel obtained a court
> order requiring Blue Cross to produce file documents which validated the
> effectiveness of ABA therapy for treating children with autism spectrum
> disorder. Among the documents in the Blue Cross files obtained by
> Plaintiff's counsel was a draft of a Blue Cross Blue Shield Medical
> Policy for 2005, which acknowledged the following:
>
> Applied behavioral analysis (ABA) is
> currently the most thoroughly researched treatment modality for early
> intervention approaches to autism spectrum disorders and is the standard
> of care recommended by the American Academy of Pediatrics, National
> Academy of Sciences Committee and the Association for Science in Autism
> Treatment, among others.
>
> Blue Cross' own documents further acknowledged that:
>
> The earlier the disorder is diagnosed,
> the sooner the child can be helped through treatment interventions.
>
> Mr. Mantese stated, "After we compelled Blue Cross through motion
> practice to produce all materials supporting its position that this care
> was allegedly experimental, we received numerous file documents which
> actually established that ABA therapy works and is highly effective in
> increasing the functioning of these children."
>
> Mr. Conway emphasized, "We are pleased that we were able to obtain a
> result which will require Blue Cross to pay for this important care and
> will alleviate some of the financial strain imposed on over a hundred
> families by having to pay for this care when it was covered under their
> insurance policies."
>
> Contact information for the families' attorneys follows:
>
> Gerard Mantese, Esq.
>
> Mantese and Rossman, P.C.
>
> 1361 E. Big Beaver Road
>
> Troy, Michigan 48083
>
> 248-457-9200 Office
>
> 248-515-6419 Cell
>
> John J. Conway, Esq.
>
> John J. Conway, P.C.
>
> 645 Griswold St, Ste 3600
>
> Detroit, MI 48226
>
> 313-961-6525 Office
>
> 313-574-2148 Cell
>- 1c.
Re: Blue Cross Blue Shield of Michigan Forced to Pay for Autism Car
Posted by: "Mindy Smith-Pace" wesfranciemom2001@... wesfranciemom2001
Sat Jun 20, 2009 3:05 pm (PDT)
Hmm, I wonder if this will help my case. We have blue cross blue shield of GA. I have been told they cannot pay for a BCBA or ABA. Our doc recently told us our 8 year old could use some ABA regarding some of my concerns but since it wont get paid for I was not sure what to do. We cannot afford it, and even medicaid here in GA does not pay for it.( She has medicaid as secondary insurance). She has autism and bipolar disorder. I will start looking into this on monday. I know a few lawyers who may help now that there is a precedant.
Melinda Smith-Pace
Muscogee County Navigator Team
Parent of 3 wonderful kids, two with awe-tism!
Wife of an amazing husband!
--- On Sat, 6/20/09, Robert W. Montgomery, Ph.D., BCBA <rwmontgomery@mindspring. > wrote:com
From: Robert W. Montgomery, Ph.D., BCBA <rwmontgomery@mindspring. >com
Subject: [opengaautism] Re: Blue Cross Blue Shield of Michigan Forced to Pay for Autism Care In Landmark Ca
To: opengaautism@yahoogroups. com
Date: Saturday, June 20, 2009, 9:14 AM
Sorry, somehow my comments at the beginning of the article did not make it into the post.
While this is Michigan it does relate to BCBS. BCBS issued a 123
page document earlier this Spring again declaring ABA Experimental.
Funny, the "experts" that wrote the document did not have the spine
to attach their names to it. This case illustrates why. The actual
data clearly says just the opposite, even when it comes from BCBS's
own files!
If anyone has BCBS Coverage and it is OUT OF MICHIGAN this may be
very important for you. Hope it helps someone.
--- In opengaautism@ yahoogroups. com, "Robert W. Montgomery, Ph.D., BCBA" <rwmontgomery@ ...> wrote:
>
> Blue Cross Blue Shield of Michigan Forced to Pay for Autism Care In Landmark Case
>
> Release issued by Mantese and Rossman, P.C., on June 19, 2009
>
> Detroit, Michigan. The family of an autistic child filed a motion in
> federal court today to confirm settlement of a class action against
> Blue Cross Blue Shield of Michigan. The family alleged in the suit
> that the insurer wrongfully refused to cover behavioral therapy for
> children with autism spectrum disorder (ASD), on the baseless ground
> that the care was "experimental. "
>
> Under the terms of the settlement reached at a court-ordered conference
> on Wednesday, June 17, 2009, Blue Cross has agreed to reimburse all
> families who paid for behavioral therapy for their children after May 1,
> 2003, and who were covered under a Blue Cross Blue Shield of Michigan
> insurance policy. Blue Cross had earlier filed a motion seeking
> dismissal of virtually the entire case on legal grounds, but the
> Honorable Stephen J. Murphy III permitted the case to go forward and
> scheduled the matter for further proceedings, including a settlement
> conference before Magistrate Michael Hluchaniuk.
>
> The settlement was reached in the case of Christopher Johns v. Blue
> Cross Blue Shield of Michigan, 08-cv-12272, filed in Detroit. In the
> suit, the plaintiff alleged that Blue Cross' pattern and practice of
> characterizing the scientifically established Applied Behavioral Therapy
> as "experimental, " and thus as excluded under its insurance policies,
> was arbitrary, capricious, illegal and contradicted by many years of
> scientific validation.
>
> Under the settlement, Blue Cross will pay for behavioral therapy
> rendered to over 100 children in the last six years. Plaintiff's
> counsel, Gerard Mantese and John J. Conway, were pleased with the
> settlement. Mr. Mantese and Mr. Conway issued a joint statement
> emphasizing: "No insurer should ever take this approach to needed care
> for children. Applied Behavioral Analysis therapy is supported by
> science and is not 'experimental. ' Delays by insurers in authorizing
> this treatment, when it is covered by insurance policies, should not be
> tolerated. Research shows that children with autism spectrum disorder
> need this therapy early on in life and delaying treatment can
> irreversibly prevent them from achieving their full potential."
>
> Mr. Mantese emphasized that the settlement includes even families who
> never submitted a claim to Blue Cross, but who obtained this care for
> their children and were covered by a Blue Cross policy. Mr. Conway
> believes that this is the first such settlement addressing Applied
> Behavioral Analysis (ABA) in the country.
>
> ABA therapy is administered under the supervision of licensed
> psychologists and other professionals. ABA applies one hundred year old
> concepts of changing behavior through positive and negative
> reinforcements. The federal suit in which this settlement was achieved
> centered upon the ABA treatment provided by prestigious Beaumont
> Hospital and its HOPE Center, including Dr. Ruth Anan and Dr. Lori
> Warner.
>
> The case settled shortly after Plaintiff's counsel obtained a court
> order requiring Blue Cross to produce file documents which validated the
> effectiveness of ABA therapy for treating children with autism spectrum
> disorder. Among the documents in the Blue Cross files obtained by
> Plaintiff's counsel was a draft of a Blue Cross Blue Shield Medical
> Policy for 2005, which acknowledged the following:
>
> Applied behavioral analysis (ABA) is
> currently the most thoroughly researched treatment modality for early
> intervention approaches to autism spectrum disorders and is the standard
> of care recommended by the American Academy of Pediatrics, National
> Academy of Sciences Committee and the Association for Science in Autism
> Treatment, among others.
>
> Blue Cross' own documents further acknowledged that:
>
> The earlier the disorder is diagnosed,
> the sooner the child can be helped through treatment interventions.
>
> Mr. Mantese stated, "After we compelled Blue Cross through motion
> practice to produce all materials supporting its position that this care
> was allegedly experimental, we received numerous file documents which
> actually established that ABA therapy works and is highly effective in
> increasing the functioning of these children."
>
> Mr. Conway emphasized, "We are pleased that we were able to obtain a
> result which will require Blue Cross to pay for this important care and
> will alleviate some of the financial strain imposed on over a hundred
> families by having to pay for this care when it was covered under their
> insurance policies."
>
> Contact information for the families' attorneys follows:
>
> Gerard Mantese, Esq.
>
> Mantese and Rossman, P.C.
>
> 1361 E. Big Beaver Road
>
> Troy, Michigan 48083
>
> 248-457-9200 Office
>
> 248-515-6419 Cell
>
> John J. Conway, Esq.
>
> John J. Conway, P.C.
>
> 645 Griswold St, Ste 3600
>
> Detroit, MI 48226
>
> 313-961-6525 Office
>
> 313-574-2148 Cell
>Need to Reply?Click one of the "Reply" links to respond to a specific message in the Daily Digest.
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