Another Class Action Filed Against Blue Cross Blue Shield of Michigan Over Its Refusal To Pay for Applied Behavior Analysis Therapy for Autistic Children

DETROIT, July 22 /PRNewswire/ -- A school teacher is the latest person to sue Blue Cross for refusing to authorize payment for applied behavior analysis (ABA) treatment for children with autism. Karen Barkowska filed a class action today in Wayne County Circuit Court against Blue Cross Blue Shield of Michigan, and its educational arm, Michigan Education Special Services Association (MESSA), over its characterization of ABA therapy as "experimental."

ABA therapy is known to be extremely effective in treating children with autism if given at an early stage of development. It is scientifically validated and includes positive reinforcements and individual goal setting, to achieve dramatic behavior modification.  ABA therapy allows children with autism the opportunity to reach maximum potential and the hope of becoming independent in their adult lives.  With virtual unanimity, physicians, psychiatrists, psychologists, social workers and mental health professionals, including the United States Surgeon General, the National Institute of Health, and the American Academy of Pediatrics regard ABA therapy as an extremely effective treatment for autism. Yet, Blue Cross refuses to afford this therapy to autistic children.

Gerard Mantese of Troy, Michigan, the lead attorney representing Barkowska, stated: "We prevailed against Blue Cross earlier this year, in the case of Johns v Blue Cross, when Blue Cross was forced to pay for ABA therapy at Beaumont's GIFT program.  That settlement covered approximately 100 families who had ABA therapy for their children.  Blue Cross said that the therapy was experimental but we showed from Blue Cross's own internal files that the care was not experimental but was scientifically based."

Under the terms of the settlement in Christopher Johns v. Blue Cross Blue Shield of Michigan, 08-cv-12272, filed in federal court in Detroit, Blue Cross agreed to reimburse all families who paid for applied behavior analysis therapy for their children at Beaumont's GIFT program from May 1, 2003 through May 1, 2009, and who were covered under a Blue Cross Blue Shield of Michigan insurance policy.  Blue Cross had earlier filed a motion seeking dismissal of virtually the entire case on legal grounds, but Judge Stephen J. Murphy III permitted the case to go forward and scheduled the case for further proceedings.

Mr. Mantese added: "The settlement, as confirmed by a federal judge earlier this year, required Blue Cross to pay for ABA therapy for a six year period.  It is unconscionable that Blue Cross is still taking the position that this therapy is experimental.  This insurer is attempting to wear down parents who are trying to access this care for their children.  We will not stop until Blue Cross recognizes the fact that ABA therapy is not experimental."

Trial in the Barkowska matter is expected to be scheduled for a date in 2011.

SOURCE Mantese Honigman Rossman and Williamson, P.C.