Class Certification Granted Against Blue Cross/Blue Shield Over Denial of ABA Therapy for Autism

On July 14, 2011 a Federal Judge in Detroit, Michigan entered an Order granting parents with autistic children class certification against Blue Cross/ Blue Shield for denying coverage of autism treatment. The Order represents a major victory for parents with autism. Plaintiffs, Michael Potter and Brett Boyer, have children with autism and sought reimbursement from their insurance company, Blue Cross/ Blue Shield (“BCBS”) for medical costs associated with a type of autism treatment known as Applied Behavioral Analysis (“ABA”). BCBS denied coverage of the ABA treatment on the basis that it was “experimental” and “investigative.” Plaintiffs, however, provided evidence that ABA therapy is a well-recognized and scientifically valid form of autism treatment and significantly improves the functions of children with autism. BCBS argued against class certification on the grounds that the proposed class lacked “definiteness” since it would be nearly impossible for the Court to determine which BCBS members have children with autism who received the ABA treatment. Judge Stephen J. Murphy, III, who wrote the opinion, declined to entertain BCBS’s argument explaining that it is BCBS’s longstanding and unwavering policy to deny coverage for all ABA treatment on the basis that it is experimental and that BCBS makes these decisions without any consideration for each of the claimant’s individual medical needs. Judge Murphy went on to explain that the claims of the class depend upon one common issue—whether ABA treatment is mainstream medical treatment or experimental. All of the class members’ claims rise or fall with the answer to that question. The Order was issued in the case of Potter v. Blue Cross Blue Shield of Michigan, No. 10-cv-14981 (E.D. Mich). Judge Murphy’s ruling provides precedent to the federal court in Philadelphia who is reviewing a motion for class certification in a lawsuit brought by the father of an autistic child against CIGNA Insurance over its policy of denying insurance coverage for ABA therapy. The attorneys at Balkan & Patterson, LLP are experienced in class action litigation and will act to protect consumers against corporate wrongdoers. If you believe you have potential for a class action, please contact us immediately and we will review your case at no charge.
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