California Officials Come Under Fire for Action on Autism Treatments

The advocacy group Consumer Watchdog is voicing concerns about potential revisions to California guidelines governing appeals for health insurers' coverage of autism treatments, and the group's founder has threatened to sue the state Department of Managed Health Care over the issue, the Los Angeles Daily Journal reports.

In a letter to DMHC officials this week, Consumer Watchdog founder Harvey Rosenfeld said he would sue the agency if it revises guidelines to make it easier for health insurers to deny coverage for autism treatments (George, Los Angeles Daily Journal, 2/24).

The dispute centers on insurers' rejection of claims for behavioral therapies for autism. 

Insurers initially argued that the treatments were not medically necessary, but independent physician panels reviewing appeals filed with DMHC concluded that the treatments were medically necessary (Girion, Los Angeles Times, 2/25). 

Anthem Blue Cross of California, Kaiser Permanente and other health plans then said that they denied coverage because the treatments are educational and "not a health care service."

DMHC officials have acknowledged that they are re-writing coverage guidelines to address the change, the Daily Journal reports (Los Angeles Daily Journal, 2/24).

Charles Bacchi, interim president of the California Association of Health Plans, said that requiring insurers to cover behavioral therapy will drive up premiums (Los Angeles Times, 2/25).