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Blue Cross ordered to defend stance on autism therapy coverage

DETROIT -- A U.S. District Court magistrate has ordered Blue Cross Blue Shield of Michigan to produce documents to support its claim that a certain type of behavioral therapy for children with autism is experimental, and therefore ineligible for coverage.

The order, issued last week by U.S. Magistrate Michael Hluchaniuk, states the insurer must also produce all documents related to any studies done by Blue Cross regarding Applied Behavior Analysis Treatment and any data reflecting how many of its insured or their dependents have autism. The order says the document must be filed with the court by March 25.

Christopher Johns, a Warren father whose 7-year-old son is autistic, is suing the insurer because his claims for this son were denied on the basis that such treatment is experimental. Johns filed the suit in federal court in May and said he is seeking a class action because more than 7,000 children in Michigan have autism, a neurological disorder that can cause children to become withdrawn, nonverbal and avoid eye contact.

Data from the federal government show that one in 150 American children has the disorder.

Officials with the insurance group have said long-term studies on autism educational therapies have been inconclusive and the treatments are experimental. Michigan law doesn't mandate coverage for such therapies.

Blue Cross spokeswoman Helen Stojic said Monday she needed to look at the order before making a comment, but said the order was not unusual.

Attorney Mark C. Rossman, who represents Johns and other parents seeking class action status, said Blue Cross has refused to produce the documents for the last nine months.

"We asked for the documents in July. They are statistical studies on autism and reports and studies and documents on which they base their determination it should be excluded," Rossman said. "It should be interesting material, and in my opinion, it's a significant development in this case."

You can reach Jennifer Chambers at (248) 647-7402 or jchambers@detnews.com.

Source: http://www.detnews.com/apps/pbcs.dll/article?AID=/20090309/METRO/903090407/1409/METRO