October 22, 2015

Insurance companies pay First Steps Program and Thompson Foundation for Autism after reaching a settlement with Missouri Department of Insurance

Health insurers agree to pay autism claims as required by Missouri's landmark autism

Jefferson City, Mo. – The Missouri Department of Insurance recently reached a settlement agreement with the Chesapeake Life Insurance Company, the Mega Life and Health Insurance Company and Mid-West National Life Insurance Company of Tennessee. The agreement centered on allegations made by the department that the health insurers failed to make required offers of autism insurance coverage to individual certificate holders of association group policies. The department also alleged the insurers failed to make required payments to the First Steps Program from 2011 – 2014.

First Steps offers coordinated services and assistance to young children with special needs and their families. First Steps is designed for children, birth to age 3, who have delayed development or diagnosed conditions that are associated with developmental disabilities.

"Missouri’s landmark autism mandate was passed because insurance coverage for autism spectrum disorders can be life changing for many thousands of Missouri children and their families," said Missouri Department of Insurance Director John M. Huff. “Consumers purchasing health insurance should know that as the state’s chief insurance regulator, I will ensure that insurers are complying with all mandated coverages enacted by our legislature. When regulators discover that insurers do not comply, I will take all necessary measures to make consumers whole."

In 2010, Gov. Jay Nixon spearheaded the bi-partisan effort to pass the law mandating the coverage of autism diagnosis and treatment. For the first time, insurance companies were required to cover one of the most highly effective types of therapy, Applied Behavioral Analysis, or ABA. While effective, the cost of ABA can exceed tens of thousands of dollars a year, making insurance coverage necessary for most families.

In the settlement the health insurers agree to review their compliance with Missouri mandates. The three companies together will pay $106,706 to the First Steps Program. The companies have now reviewed their claim files since 2011 to determine if any claims for autism coverage were improperly denied and have paid those claims identified in the review. The insurers will also notify policyholders that coverage for autism spectrum disorders is available and that it will pay claims in accordance with state law. Finally, insurers will make a $15,000 donation to the Thompson Foundation for Autism at the University of Missouri to serve Missouri families impacted by autism spectrum disorders.