Parents Claim Banner Health Denies Coverage for Autistic Child

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An Arizona doctor and his wife are the plaintiffs in a proposed class action lawsuit filed on behalf of their minor child who suffers from autism. The lawsuit names Banner Health, one of its health plans, and the plan administrator as defendants, and claims that they violated federal law by failing to provide coverage for treatment of the child’s autism. The plaintiffs allege that their son began Applied Behavioral Analysis (ABA) while his father was in medical school, but that the treatment was no longer covered once the father began working for Banner Health. According to the suit, ABA is “the most common and recognized method of treating autism,” but Banner Health considers it “experimental or investigative” and does not cover it under its health insurance plan.

The suit argues that the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) prevents health plans that provide mental health benefits from limiting those benefits more than their medical/surgical benefits. It further claims that Banner’s decision to exclude ABA from its covered treatments while still providing assistance to plan members with medical bills violates the MHPAEA.

The plaintiffs insist that ABA is a “scientifically valid, medically accepted, mainstream treatment,” and that their child has been responding very well to it. They have continued his ABA treatment, but have unfairly been forced to pay its expenses out-of-pocket, according to the complaint.