On September 28th, a federal court judge in Portland ruled in favor of the McHenry family in their suit against PacificSource, ordering the insurance company to cover the cost of ABA treatment for their 6-year old son with autism. The ruling was based in large part on Oregon’s existing Mental Health Parity law, and included many critical decisions:
- ABA therapy is not experimental or investigational in nature and PacificSource lacked a reasonable basis for reaching the opposite conclusion
- ABA is a medical intervention, and is not subject to the exclusions under the Plan for academic or social skills training
- A provider “is eligible for reimbursement” under Oregon law if the provider is approved by the Department of Human Services; an ABA provider need not be credentialed with the insurance company to be considered an eligible provider
- PacificSource breached its fiduciary duty, and must provide retroactive reimbursement to the moment at which the McHenry family’s provider was approved by the Oregon Department of Human Services
We are continuing to move forward with our autism health insurance reform bill – it will further strengthen and clarify the rights of individuals with autism to receive meaningful health insurance coverage for symptoms associated with autism.
However, this court ruling does establish a legal precedent that Oregon’s existing laws already mandate insurance coverage for autism, including ABA. (The same legal principles should apply to other forms of autism treatment – but the legal opinion was particularly emphatic in declaring ABA therapy to be evidence-based).
In light of this, we’re organizing an Autism Health Insurance Workshop on Saturday, November 6th, to help individuals with autism and their families to get insurance reimbursement right now (even retroactively), under Oregon’s existing Mental Health Parity law. This workshop will:
- Explain the existing law and legal ruling in the McHenry case
- Show how to determine if your policy is covered by Mental Health Parity (or find a new policy that is)
- Explain the process an autism provider can follow to become DHS approved (it’s pretty easy!)
- Describe how to prepare your claim for reimbursement
- Extend an offer for ongoing assistance in completing the paperwork and processing appeals if necessary
We want to help as many people as possible to get the insurance reimbursement that they need, right away, and to hold the insurance industry accountable for obeying Oregon’s existing laws.
You can find more information about this important legal ruling – including copies of the judge’s legal decisions – at: http://sites.google.com/site/orautismcoverage/breakingnews!
Autism Health Insurance Workshop
Date: Saturday, November 6th
Time: 4:00 PM to 6:00 PM
First United Methodist Church
1838 S.W. Jefferson Street
Portland, Oregon 97201
A map of the church building can be found here: http://fumcpdx.org/pdf/FUMC_map_2007_color.pdf
Thanks everyone for your help in getting us to this point!
– Paul Terdal,