O.S.T. and L.H. – their initials in court documents – are minors diagnosed with autism. Their families sued Regence, the health insurance company, for not covering all therapies related to their condition.
Treatment for autism varies, but the therapies are mainly to help promote a child’s social skills and language development.
Now the state Supreme Court will decide whether health carriers must cover all autism therapies.
Regence Blue Shield is appealing a lower court ruling that ordered the carrier to cover neurodevelopmental therapies, which includes speech, occupational and physical therapy.
State law doesn’t mandate carriers to cover autism treatments.
On Thursday, lawyers for two families and their autistic children argued that Regence Blue Shield violated state law by refusing to pay for their treatments.
Eleanor Hamburger told the court that Washington’s Mental Health Parity Act requires carriers to cover these services.
“That’s exactly what the Parity Act promised, fair treatment for people when they have mental health conditions, just like people who have physical conditions,” Hamburger said.
Most major health carriers in Washington have covered autism therapies since 2011, after a number of parents sued. Last month, Premera Blue Cross agreed to a settlement and lifted its restrictions on autism therapy.
Regence now stands alone.
Timothy Parker, who represents Regence, told the court that the providers for neurodevelopmental therapies are not mental health providers.
Although the Legislature has required health insurance policies to cover neurodevelopmental therapy since 1989, there were restrictions. It only applied to employer-based health plans, and it covered children under age six.
“The Legislature was asked, after the adoption of the Mental Health Parity Act, to expand the scope of the neurodevelopmental therapy mandate,” Parker said. “The Legislature considered it, and due to consideration of cost, they refused to expand the neurodevelopmental mandate.”
Parker says there’s an age limit because families can seek services through schools if additional therapy is required.
It will be months before the court issues a ruling. If the decision favors Regence, it could change existing settlements.