National Lawsuit Filed to Allow CIGNA Coverage of ABA Therapy for Autism

Advertisement

Historically, Applied Behavior Analysis (ABA) has not been covered by most insurance plans but as time has proven the therapy to be one of the most effective treatments for autism spectrum disorders, an increasing number of companies are adding the benefit. CIGNA Insurance, though, has a nationwide policy of classifying ABA as experimental and therefore does not provide coverage. A new lawsuit filed this week in Philadelphia could change that.

Applied Behavior Analysis (ABA) is the application of principles of learning and motivation into interventions that improve socially significant behaviors which include reading, academics, communication, and adaptive living skills. ABA methods support people with autism in increasing positive behaviors and social interactions, reducing interfering behaviors, and teaching new skills.

Over the past 40 years, several thousand published research studies have documented the effectiveness of ABA, according to a report by the MADSEC Autism Task Force in 2000. In fact, ABA therapy initiated early has allowed many children to forgo costly intensive special education in the future, thus reducing overall expenses for families dealing with the disability.

Advertisement

The plaintiff is Kristopher Churchill, the father of an autistic child, who states that classification of ABA therapy as experimental violates federal laws governing insurance plans. He notes that numerous authorities and organizations support ABA to treat autism, including the US Surgeon General and the National Institutes of Health.

Currently, there are 27 states with Autism Insurance Reform Laws including Pennsylvania where the lawsuit was filed. Autism Votes, an initiative of Autism Speaks, is working to change state insurance laws so that all will require private health insurance policies to cover the diagnosis and treatment of autism spectrum disorders. Currently, only Georgia, Idaho, Mississippi, Oklahoma, South Dakota, Tennessee, Wyoming, and Washington DC are not currently pursuing Autism Insurance Reform.

The Patient Protection and Affordable Care Act (PPACA) will provide coverage for behavioral therapies beginning in 2014.

Mr. Churchill is represented by Gerard Mantese and John Conway of Michigan, and Gregg Heller of Pennsylvania. The judge in the case is Juan R. Sanchez.

For more on health insurance coverage of ABA Therapy and other autism-related services, please also read:
BCBS Michigan Provide Coverage for Autism Therapy
Health Insurance Coverage of Autism for Debate in North Carolina
Virginia House Panel Nixes Health Insurance for Autism

Advertisement