Wednesday, December 8, 2010

Empire BCBS Sued Over Denial of Autism Coverage

Empire Blue Cross ("BCBS") has been sued in federal court in Michigan for allegedly denying health care coverage for autism treatment. Two Michigan residents filed a proposed class action against BCBS earlier this week contending that the insurer ERISA by systematically denying payment for certain treatments for autism. See Lorigan v. Empire Blue Cross Blue Shield, E.D. Mich., No. 10-14842. The lawsuit alleges that BCBS violates ERISA each time it refuses to pay for “applied behavior analysis” ("ABA") received by autistic children insured by BCBS health plans. There have been previous attempts to bring ERISA class actions against BCBS in the past. The lawsuit also alleges that ABA treatment is a “scientifically valid, medically accepted, and mainstream treatment” for autism spectrum disorder, and that by refusing to pay for ABA treatment, Empire Blue Cross has violated the terms of its ERISA health insurance plans.

Other cases have challenged the same actions of other Blue Cross Blue Shield Plans. In March 2009, a federal court in Michigan denied a class certification motion in a health plan participant's case challenging Blue Cross Blue Shield of Michigan's refusal to pay for ABA therapy. In another case dismissed earlier this year, Blue Cross Blue Shield of Tennessee Inc. was also targeted in an ERISA class action over its refusal to pay for ABA treatment. The case was dismissed earlier this year by the U.S. District Court for the Eastern District of Tennessee