Lucas Camilo

As some of you may know, we’ve been involved in a lawsuit against one of the biggest health insurance companies (Regence Blue Shield) since we moved to Seattle a few years back.  An amazing lawyer named Ele Hamburger brought the case against Regence (after winning settlements with the other two largest insurers in the state) over their denial of coverage for “neuro-developmental” therapies.  Though the case focused on Applied Behavior Analysis therapy (ABA), Lucas had the potential to be included because he has required speech, physical, and occupational therapy since early in his life due to his disability.  Therefore, we were asked if Lucas would be a named plaintiff in the lawsuit.  Always up for a good fight, Lucas said yes, and the case has been in the courts ever since.

Well, a few weeks ago Lucas and his fellow plaintiffs (other kids with developmental disabilities) won!  Or rather, the lawyers reached a very favorable settlement requiring Regence to pay $6 million to families who were denied the coverage.  More importantly, going forward thousands of kids with disabilities (primarily but not exclusively autism) will now be able to get the neuro-developmental therapies they need – fully covered by insurance – without any low, artificial limits on number of visits.  It’s shameful that Regence and other insurers denied or limited such coverage in the past, and awesome that Ele and her team forced them into the settlement. (The settlement still needs to be approved by the judges but it seems likely that it will be.)

It turned out to be  a double victory as the Washington state supreme court subsequently ruled that Regence was violating the Mental Health Parity Act by denying coverage to these kids.  As the article says:

“A unanimous state Supreme Court ruling last week provided mental-health advocates with a powerful tool to ensure equal insurance coverage for disorders of the brain and body.  In unequivocal language, the justices tossed out a blanket exclusion of coverage for childhood autism treatments imposed by Regence BlueShield, the state’s largest insurer.”

And that wasn’t all.  After the ruling, the state Insurance Commissioner then declared that all Washington state insurance companies (not just Regence) must notify policyholder that they have the right to review claims going back to 2006. Once claims have been re-evaluated, the insurance companies will be liable to pay for any coverage that was denied in violation of the act.

So even as we’ve continued to struggle with some issues related to Lucas’s school this week and the fact they still haven’t hired a 1-to-1 aide for him (a subject for a separate blog post), we’re feeling good about this victory and excited to share it with you all.  Already some friends who have a daughter with special needs have been in touch with the lawyer here in Seattle about help moving forward on a similar suit in another jurisdiction.

In the meantime, we celebrated last weekend by going shopping for Halloween costumes at Goodwill :)