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Applied Behavioral Analysis Suit Wins Class-Action Status

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WASHINGTON BUREAU — A lawsuit over coverage for applied behavioral analysis (ABA), a therapy used for treating autism, has won class-action status in the U.S. District Court in Philadelphia.

The plaintiffs in the case, Churchill vs. CIGNA, Number 10-6911 (Eastern District of Pennsylvania), allege that CIGNA HealthCare, a unit of CIGNA Corp., Philadelphia (NYSE:CI), wrongly denied coverage for ABA therapy.

U.S. District Judge Juan Sanchez certified the case for class-action status in a memorandum ruling.

Class-action status is appropriate because CIGNA had a national policy of denying coverage for ABA therapy on the ground that ABA therapy is experimental, Sanchez says in an opinion explaining the ruling.

The plaintiffs, enrollees in employer-sponsored plans governed by the Employee Retirement Income Security Act (ERISA), are seeking reimbursement for denied claims and injunctive relief to stop the ABA coverage exclusion.

At CIGNA, “we do not comment on pending litagation,” said Joe Monday, a company spokesman.

Lawyers at Mantese Honigman Rossman and Williamson P.C., Troy, Mich., the firm that is organizing the CIGNA suit, also have filed similar suits against two nonprofit insurers, Blue Cross Blue Shield of Michigan, Detroit, and TRICARE, the health plan for military personnel, dependents and retirees who seek care away from military and veterans’ facilities.

The Michigan Blue suit was settled in 2009, according to John Conway and Gerard Mantese, lawyers at Mantese Honigman.

Under the terms of that settlement, coverage was required for the specific course of therapy provided by a local hospital. The settlement also required reimbursement for all of the covered participants in the program going back 6 years, with no deductibles and no co-pays, the lawyers say.

The lawyers say that 26 states now mandate ABA coverage.

Other autism treatment benefits coverage from National Underwriter Life & Health: