California Insurance Commissioner Dave Jones announced two more health insurers have agreed to guarantee coverage for behavioral therapy for autism.
Health Net and Cigna signed settlement agreements to provide the coverage whenever medically necessary. Last month, the California Department of Insurance reached a similar agreement with Blue Shield of California Life and Health Insurance Co. Jones also confirmed that another major health insurance company, Anthem Blue Cross of California, has been providing coverage for behavioral therapy for autism since November 2009 at the department's direction.
"These agreements mean more families with autistic children won't have to lose sleep over whether or not they can afford a therapy that's been proven to transform lives," Jones said in a press release.
As part of the settlements, Health Net and Cigna agreed to maintain adequate provider networks and create customer service units or support teams specially trained to handle inquiries about an autism therapy known as "applied behavior analysis therapy." The units or teams will respond to requests for coverage or authorization and for payment. The health plans also agreed not to reject any claims for applied behavior analysis therapy.
Before the settlements were reached, both health insurance companies rejected claims for the therapy, according to the department. Anthem stopped denying coverage for the services in response to the department's direction in November 2009, and since then has been offering behavioral therapy as part of its in-network benefits.
Jones said the agreements ensure that the companies comply with the state's Mental Health Parity Act, which requires coverage for medically necessary behavioral therapies. To further reinforce the law's requirements, the Legislature last year passed a bill requiring health insurance plans to cover behavioral therapy for people with autism and pervasive development disorder. The law goes into effect July 1 and expires in two years.
The California Department of Insurance regulates most preferred provider organization health plans and all individual health insurance plans. The California Department of Managed Care regulates health maintenance organizations.