Family Wins Case In Autism Coverage Lawsuit

Anthem Ordered To Cover Costs Of Autism Therapy

Abby Tappert was diagnosed with autism two years ago. At the time, her mother, Jill, said Abby couldn't talk or socialize like other kids.

Like most mothers, Jill Tappert searched for treatment plans -- anything that would help her daughter live as normal a life as possible.

Today, Abby is quite capable of having a conversation at the lunch table.

She even has an extensive dinosaur collection that she loves to line up and name off.

Her mother credits Abby's remarkable progress to a treatment plan called Applied Behavior Analysis or ABA.

The only problem with the plan was it wasn't covered by their insurance company and it wasn't cheap. In fact, two years of treatment cost the family about $110,000.

But, Jill Tappert didn't give up.

She launched appeal after appeal and finally called in a lawyer.

Last week, an arbiter sided with the Tapperts and awarded them $110,000.

It was an important decision for the Tapperts and other families of autistic children across the U.S.

"I do think it sets a precedent for some families, families that have a PPO policy with Anthem including other states. (They) will be able to look at the ruling and go Anthem's policy is flawed. ABA is the standard of care in treating autism," said Tappert.

But, Anthem Blue Cross/Blue Shield said not so fast.

In a statement the company said: "This decision is not a broad-based declaration that ABA therapy is 'medically necessary' in all cases. To what extent this type of therapy should be covered...should be made by legislators and/or the division of insurance."

The ruling's implication is still unknown but the Tapperts said it's a step in the right direction.

Anthem said several insurance companies do not currently provide ABA coverage.

They said if a family would like to make a claim for ABA coverage they will evaluate them on a case-by-case basis.

Family Voices of Colorado helps families with the appeals and filing process. You can contact them at 1-800-881-8272 or via the Web at familyvoicesco.org

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