The California Department of Insurance (CDI) announced today that it has issued an Order to Show Cause against Blue Shield of California Life and Health Insurance Company for failing to comply with the California Mental Health Parity Act. Enacted in 1999, the law requires private insurance plans to provide equal coverage for selected mental health conditions and physical conditions.
At a hearing of the Senate Select Committee on Autism, representatives from CDI explained that Applied Behavior Analysis (ABA) therapy, a common and proven approach toward improving the lives of children with autism, is required to be covered by insurers under California’s mental health parity law. Furthermore, the representatives highlighted independent medical reviews (IMR’s), which showed ABA to be necessary therapy.
“Our purpose and goal is to ensure that insurance companies are in full compliance with California’s mental health parity law,” Adam Cole, General Counsel at CDI, said. “CDI is taking this action to address the barriers faced by families attempting to obtain behavior therapy and increase their access to proven transformative therapies.”
CDI has filed an enforcement action to make Blue Shield comply with California’s mental health parity law. The Department asserts that Blue Shield violated the law by:
-Denying coverage on the ground that ABA isn’t “medically necessary”
-Denying coverage on the ground that ABA is “experimental”
-Denying coverage on the ground it is available only for services performed by a licensed provider and ABA providers are not licensed
-Denying coverage on the ground that ABA is not a “health care service,” but instead is a service for “learning disabilities or behavioral problems or social skills training/therapy”
Not including ABA providers in its network
Refusing to provide insureds with definitive denials of coverage within 30 days of receiving a claim, thereby preventing insureds from invoking IMR
The action comes after the parents of two autistic children sought the Department’s assistance when Blue Shield refused to approve coverage for Applied Behavior Analysis (ABA) therapy recommended by their children’s physicians. ABA therapy is based on behavioral conditioning techniques and reinforcement of positive behaviors to shape behaviors and teach new skills. Blue Shield claims it is experimental. “Decades of research show it to be a successful and well-established treatment for autism and not an experimental or investigational treatment,” said Mr. Cole.
After the children were denied coverage for the treatment, the parents sought IMR by CDI, which found that ABA therapy was medically necessary in both cases, but Blue Shield refused to comply with the binding determinations in the IMR decisions. In addition, when CDI sent out a request to all insurers to identify their provider networks, as required by law, Blue Shield refused to submit a provider report and roster.
In response to the company’s unwillingness to submit its provider networks and its refusal to initially cover ABA for the individuals who complained, the Department is issuing a cease and desist order.

Hello. My name is Tracy and less than 3 years ago my son Noah was diagnosed with Autism. At that time Noah had very little eye contact, little speech (only one word echolalia), symptoms such as: non-verbal, non-social, toe-walking, spinning, lining/stacking toys, self-injurious behavior, poop smearing, very little sleep, etc.
 
After spending a year trying to figure out what was wrong with my son (Regional Center, Pediatrician, etc.) I finally got a referral to have him evaluated through the school district; finally, I got answers… my son has autism. I took that evaluation and went back to the Regional Center and had Noah properly diagnosed by a Clinical Psychologist. When we got his diagnosis we immediately put him on a GFCF and Soy Free diet… three weeks later I got my first “I love you mama” from my son. We took him to see a DAN doctor in Santa Monica (Dr. Rachel West) where she ran several tests on my son. Once the results came in we had to put him on a strict diet to clean out his gut out because he had a bad case of Candida, which meant no sugar, no gluten, no casein, no soy, and no yeast. His gut is now clean and he is functioning better than ever… no self-injurious behavior, more eye contact, better sleep, more social, etc. He still has some auditory processing issues, but it is all very minor. We also got him 30 sessions of HBOT which really improved his motor skills; we saw the most improvements with this treatment.
 
Noah has come a long way with all the Biomedical Treatment that he has received. He still continues with the GF/CF and SF diet with some occasional cheating in which we just give him extra enzymes to break down the proteins.
 
I started Autism Recovery to educate parents on the benefits of alternative treatment for their children. The problem is that this treatment can be costly and the bigger problem is that a lot of children are not being diagnosed properly. Autism Recovery’s mission is to provide every child in the Los Angeles area access to early screening and intervention for an autism spectrum disorder and assist them on their road to recovery through means of biomedical treatment.
 
Our goal is to create a mobile clinic. The Autism Recovery Mobile Clinic will allow families to meet with clinicians in their local communities. Research has found that early identification and intervention are vital to improving the development outcomes of children with autism. The Mobile Clinic will provide direct assistance to parents through education while offering access to local resources and treatment options. The Mobile Clinic is a customized RV with screening rooms, a comfortable waiting room, a resource room, and an office. All services will be provided FREE of charge by highly qualified professionals with extensive experience. Our future plans are to expand and be in every major city in every state across the United States.