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Anthem, Blue Shield to Cover Therapy for Children with Autism - featured July 20, 2011

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[Source: LA Times]

Two of California's largest health insurers have agreed to pay for costly behavioral therapy for thousands of autistic children — services the companies have long resisted covering.

Under pressure from regulators, Blue Shield of California and Anthem Blue Cross said they would pick up the initial cost of a treatment known as applied behavior analysis.

Insurers, worried about rising demand for expensive services as the number of autism cases grows, have argued that the therapy is not a medical treatment but an educational or social service exempt from coverage.

Anthem and Blue Shield settled their dispute with the California Department of Managed Health Care to avoid penalties or other enforcement actions, officials said. The companies agreed to the settlements but acknowledged no wrongdoing.

Both insurers have agreed to cover a minimum of six months of treatment for HMO patients as long as the services are deemed "medically necessary" by healthcare providers and offered under the supervision of licensed professionals.

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Tags: News of the Week Autism Newsletter 22 July 2011