Skip to main content

Originally published May 19, 2014 at 5:02 AM | Page modified May 19, 2014 at 12:29 PM

  • Share:
  • Comments (0)
  • Print

Settlement lifts Premera’s restrictions on autism therapy

Premera Blue Cross has agreed to remove restrictions on neurodevelopmental therapies and pay $3.5 million to parents, according to a settlement reached in three class-action lawsuits — the latest in a string of successful actions on behalf of children with autism.

Seattle Times health reporter

Reader Comments
Hide / Show comments
Why should it take a private lawsuit to get insurance law enforced relative to a "nonprofit" insurer that with over $1... MORE


Premera Blue Cross and its subsidiary, LifeWise Health Plan of Washington, will remove restrictions on neurodevelopmental therapy for autism and set aside $3.5 million to reimburse policyholders who paid for therapy out of pocket.

Under the settlement agreement, Premera and Lifewise will remove age limits and treatment limitations from any medically necessary speech, occupational and physical therapy. The change will apply to all insured plans issued by Premera and LifeWise in Washington.

The settlement is the latest to emerge from a string of lawsuits brought against insurers, employers and state agencies that restrict or limit neurodevelopmental therapy such as applied behavior analysis.

The final settlement agreement in the Premera case, reached in three class-action lawsuits in King County Superior Court and in U.S. District Court in Seattle, must be preliminarily approved by the three judges.

The lawsuits were brought by five individuals diagnosed with autism and their parents, alleging the restrictions violated the Washington State Mental Health Parity Act, which requires equal coverage for mental and physical services.

The settlement was agreed to after five days of negotiations with the aid of three mediators, according to court papers filed Friday in one of the King County cases.

Applied behavior analysis (ABA), one of the autism therapies, has been at issue in more than a dozen class-action lawsuits against insurers in Washington and Oregon.

The law firm in the current case, Sirianni Youtz Spoonemore Hamburger of Seattle, has brought most of those; a case against the state for Medicaid coverage was settled in 2012 by Northwest Justice Project, a statewide legal-aid project. All have settled in favor of plaintiffs.

Premera spokesman Eric Earling said in a statement that the insurer has previously gone beyond state requirements for neurodevelopmental therapy, which mandate therapy for children under age 7 for group plans. He said the company has covered children beyond age 7 and those in individual plans.

However, he said, “Premera is forgoing additional appeals in the interest of resolving the matter and moving forward for its members.”

Melissa Menti, of Bellingham, the mother of a 20-year-old with autism who was a plaintiff in one of the lawsuits, said in a statement that ABA therapy changed her son’s life when he was a teenager.

“ABA therapy helped my son to develop the behaviors he needs to live on his own and lead a productive and full life,” Menti said. “I am so glad that other children will now have a clear way to obtain coverage of ABA.”

Rick Spoonemore, one of the plaintiffs’ lawyers, said in a statement he hoped all children would soon have access to the neurodevelopmental and behavioral therapies they need.

“This settlement agreement is a giant leap forward to that day,” he said. “Premera should be commended for working with plaintiffs to ensure full coverage and better health care for Washington children.”

Carol M. Ostrom: or 206-464-2249. On Twitter @costrom

Four weeks for 99 cents of unlimited digital access to The Seattle Times. Try it now!

Also in Local News

News where, when and how you want it

Email Icon

Time to add another piece to your Hawks collection

Time to add another piece to your Hawks collection

Check out the full lineup of championship merchandise from The Seattle Times store.


Partner Video


The Seattle Times

The door is closed, but it's not locked.

Take a minute to subscribe and continue to enjoy The Seattle Times for as little as 99 cents a week.

Subscription options ►

Already a subscriber?

We've got good news for you. Unlimited content access is included with most subscriptions.

Subscriber login ►
The Seattle Times

To keep reading, you need a subscription upgrade.

We hope you have enjoyed your complimentary access. For unlimited access, please upgrade your digital subscription.

Call customer service at 1.800.542.0820 for assistance with your upgrade or questions about your subscriber status.

The Seattle Times

To keep reading, you need a subscription.

We hope you have enjoyed your complimentary access. Subscribe now for unlimited access!

Subscription options ►

Already a subscriber?

We've got good news for you. Unlimited content access is included with most subscriptions.

Activate Subscriber Account ►