themcglynn.com

30 Jul

Judge Sues Blue Cross for Autism Treatment

“It is unfortunate that Blue Cross continues to violate its own insurance policies….”

DETROIT, July 30 /PRNewswire/ — An Oakland County Circuit Court Judge filed a lawsuit today against Blue Cross Blue Shield of Michigan. In her suit, Judge Cheryl Matthews alleges that Blue Cross wrongfully refused to cover the costs associated with the applied behavioral therapy provided to her son, who has autism spectrum disorder.

This suit was filed approximately a month after another challenge to Blue Cross’ wrongful refusal to pay for autism therapy resulted in Blue Cross paying $1,000,000 in damages. That case — Christopher Johns v. Blue Cross Blue Shield of Michigan — was the first successful challenge to an insurer’s refusal to pay for applied behavioral analysis, and the families in that case were represented by Gerard Mantese and John J. Conway.

Mantese, co-counsel for Judge Matthews, stated, “It is unfortunate that Blue Cross continues to violate its own insurance policies by refusing to provide needed health care to these children. It has already been demonstrated in the federal case we just settled for Mr. Johns that applied behavioral therapy is highly effective, yet Blue Cross persists in refusing to provide coverage. The bottom line is, these children are entitled to this care.”

The Johns v. Blue Cross suit was filed in federal court and addressed applied behavioral therapy that was provided by Beaumont Hospital. This new suit filed by Judge Matthews challenges Blue Cross’ refusal to authorize this treatment at a similarly credentialed facility, the Early Intervention Center, which is located in Southfield, Michigan. Judge Matthews stated, “The scientific studies show that this therapy helps autistic children improve their lives. Shame on Blue Cross Blue Shield for intentionally choosing to neglect autistic children.”

Co-counsel, John Conway, stated, “We will bring as many of these suits as we have to, to force Blue Cross to comply with their contracts and with the law. Blue Cross’ actions are indefensible and we expect to prevail.”

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