The California Department of Insurance announced an agreement with United Healthcare Insurance Co. to provide coverage for behavioral therapy for autism, a costly treatment that was the subject of heated debates and a fight in the state legislature last year.
The agreement follows similar deals earlier this year with Blue Shield, Cigna and Woodland Hills based Health Net. Anthem Blue Cross has been providing coverage since a settlement in 2009.
"We are pleased UnitedHealthcare joins four other insurers in fulfilling its responsibility to provide this necessary and vital treatment to the state's thousands of autistic children," Insurance Commissioner Dave Jones said in a prepared statement.
The deals follow the passage of SB 946 last fall, which required insurance companies to cover the treatment.
The California Association of Health Insurance Plans had expressed disappointment with the decision at the time saying behavioral therapy would cost the state’s insurance industry $850 million.
The treatment is said to be a critical and effective intervention for autism but can cost upwards of $40,000 per child per year.
Jones said the agreements ensure that insurance companies comply with the state’s the state’s Mental Health Parity Act which requires coverage for medically necessary behavioral therapies.
As part of the settlements, the insurance carriers have agreed to maintain an adequate provider network; provide services for the length of time, and at the number of hours per week specified by the insured's provider; and create a dedicated customer service unit with staff who are specially trained to handle inquiries about the therapy. They also have to provide information about policy benefits for medically necessary behavioral health treatment, screening or diagnosis, verify coverage or eligibility and provide prior authorization, if required.
The commissioner said that prior to this settlement UnitedHealthcare rejected claims for the therapy, calling it experimental and investigational.