Anthem insurance agrees to pay $1.6 million in settlement over autism therapy

Anthem cut Kathryn Pierce's son's autism therapy in half.
Published:
Updated:

INDIANAPOLIS (WTHR) — Families of children with autism are celebrating a major victory.

Anthem insurance has agreed to pay $1.6 million dollars as part of a settlement for denying coverage for full-time specialized therapy for children with autism.

13 Investigates reporter Sandra Chapman first uncovered Anthem's policy of cutting autism therapy more than five years ago. Our cameras have been there for the rallies and the legal steps to push for change.

The long three-year fight is over.

Indiana-based Anthem insurance has agreed to pay Kathryn Pierce and 200 other families a $1.6 million settlement for denying ABA, or Applied Behavioral Analysis, therapy for their children with autism.

13 Investigates first introduced you to Kathryn Pierce of Elkhart County and her then 12-year-old son in 2015. He was diagnosed with severe autism and could barely speak five words. Yet Anthem cut his therapy in half, saying it was not medically necessary. Worse yet, after a number of exhausting appeals Anthem told the family to "take it or leave it."

"It was devastating because my son needs as much therapy as he can get," Pierce told 13 Investigates at that time.

Pierce and her family could have simply changed insurance companies. Instead they became one of two families at the center of a class action lawsuit aimed at getting Anthem to stop a disturbing policy of denying ABA treatment when autism patients turned 8 years old.

13 Investigates first uncovered the practice in 2013 when 8-year-old Canyon Rice was denied his benefits and referred to a public school setting for assistance. Canyon could not speak sentences and also required constant attention. After several appeals, his therapy was later reinstated.

Even though Anthem restored therapy in Canyon's case, other children were still denied when they became school-aged. Indianapolis attorney Syed Ali Saeed, who helped represent the Pierce family, called the practice unlawful in 2015.

Now, after a three-year legal battle, both sides have agreed to settle the lawsuit and issued this joint statement:

"The parties are pleased to reach a resolution that ensures that Anthem members continue to receive the support they need... Anthem agreed to a monetary payment and will not use guidelines relating to coverage for ABA therapy based solely on an individual's age."

Court records show Anthem employees will get more training on autism and ABA therapy.

Members of the class action will receive an average payment or $5,000. Some of the payments range from $2 up to $36,000, depending on the amount of ABA therapy services denied.

While the families that participated in the lawsuit will benefit financially and with reinstated services, it's unclear how many other families will reap the benefits of the settlement. Many of consider this a significant step forward in providing a gold standard of care for their children.

Filed under: