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Health Net, Cigna Make Deal with California on Autism Benefits

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Two large health insurers, Cigna Corp. (NYSE:CI) and Health Net Inc. (NYSE:HNT), have agreed to cover applied behavioral analysis (ABA) therapy and similar therapies for California residents with autism whenever a behavioral therapy approach is found to be medically necessary.

Cigna, Bloomfield, Conn., and Health Net, Woodland Hills, Calif., made the deal with California Insurance Commissioner Dave Jones.

Jones negotiated a similar agreement in January with Blue Shield of California, San Francisco, and he says in an announcement of the settlement that Anthem Blue Cross, a unit of WellPoint Inc., Indianapolis (NYSE:WLP), has been providing coverage for behavioral therapy, under the direction of California regulators, since 2009.

Jones says Health Net and Cigna have:

  • Agreed to maintain an adequate provider network to enable them to provide treatment for all insureds with autism.
  • Not to reject any claims for medically necessary ABA.
  • Create dedicated customer service units or support teams specially trained to handle inquiries about ABA, requests for coverage or authorization, and for payment for ABA services.
Providing full-time ABA therapy for someone with autism can cost $30,000 to $50,000 per year.

Jones says the California Mental Health Parity Act (MHP) requires insurers in the state to cover medically necessary behavioral therapies.

In 2011, the California Legislature passed S.B. 946, an autism treatment mandate bill that is set to take effect July 1.

Jones says he believes California law already requires insurers to cover behavioral therapy for autism, even before S.B. 946 takes effect.



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