Court orders insurer to comply with mental health parity law

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A federal district court has blocked Regence Blue Shield from denying coverage of neurodevelopmental therapies to children over age 6, finding that the insurer’s policy of denying these services violates Washington state’s mental health parity law.

In July 2011, Disability Rights Washington filed a lawsuit against Regence Blue Shield, on behalf of a 9-year-old boy with autism for whom the insurer refused to cover speech and occupational therapy services.

In the first decision in the litigation, the U.S. District Court for the Western District of Washington issued a preliminary injunction against the insurer January 24, temporarily halting the insurer’s practice of barring medically necessary therapies.

“Such therapies are most effective in young children, and losing access to needed therapies in a timely manner can make reversible or treatable developmental conditions more severe, of greater long-term functional impact and, at times, devastating and unneeded consequences may be seen…,” the court stated. “Accordingly, the court finds that the balance of the hardships favors plaintiffs, particularly where it appears that the benefits of therapies reduces as the child gets older.”

The court also certified the lawsuit as a class-action lawsuit, meaning that the lawsuit will proceed on behalf of all people in the state similarly denied medically necessary therapies.

“Persons with mental health conditions have been subjected to discriminatory exclusions and limitations in health coverage for decades,” said Mark Stroh, executive director of DRW, in a news release. “This is the exact kind of discrimination that the Mental Health Parity Act was designed to end.

“As a civil rights organization and an employer, DRW had to take action to make sure that the coverage we purchase for our employees and their families does not discriminate. Today we are one step closer to ensuring that insurance coverage in Washington does not unfairly exclude persons with developmental mental health conditions.”

Disability Rights Washington, the publisher of this DisAbility Galaxy website, is part of the federally funded protection and advocacy system and a member of the National Disability Rights Network.