Indiana parents sue Anthem for denying son's full-time autism therapy

Kathryn Pierce says her son needs all the therapy he can get.
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The parents of a 12-year-old boy with severe autism has filed a class action lawsuit against insurance company Anthem for refusing to cover his full-time therapy.

13 Investigates first uncovered the practice two years ago. 

Attorneys say this 12-year-old could be anyone's son. Kathryn Pierce says he needs constant guidance. Her son speaks just five words, and is diagnosed with severe autism.

In January, after exhausting appeals, Anthem Insurance gave his parents a "take it or leave it" offer: accept half of the 40 hours of Applied Behavioral Analysis therapy prescribed by a doctor for their son or find a new carrier. In a letter to the family, Anthem said the therapy was not medically necessary.

"It was devastating because my son needs as much therapy as he can get," said Pierce.

Now the Elkhart County parents are filing a class action lawsuit against Anthem.

"It would be easy for me to look for a new insurance company and just switch, like I know other parents have done, but then all those children that have Anthem will just have their hours cut," said Pierce.

Pierce's attorney calls Anthem's actions unlawful.

"Their position is the Public Schools should be providing these services or part of these services as opposed to Anthem, and we're alleging that activity is against the Indiana mandate," said Syed Ali Saeed, attorney.

13 Investigates first uncovered Anthem's policy two years ago in a series of reports called "Caring for Canyon." Eight-year-old Canyon was also declined full coverage. Like Pierce's son, he was told to get services instead from a public school system. Since then Canyon has gained back his 35 hours.

"We want Anthem to stop implementing this policy," said Saeed.

"If I can make a difference to all the children in Indiana it's worth it to me and my family," said Pierce.

Anthem won't comment on the pending lawsuit but tells 13 Investigates it is committed to providing appropriate coverage for ABA therapy based on the member's plan.

Read the lawsuit document here.