FEDERAL JUDGE RULES IN FAVOR OF FAMILY IN LANDMARK AUTISM INSURANCE CASE IN OREGON

FOR IMMEDIATE RELEASE
Clackamas, Oregon, United States of America (Free-Press-Release.com) October 6, 2010 --

On September 28, 2010, In the United States District Court for the District of Oregon, Portland Division, a federal judge ruled that ABA therapy is a covered benefit under Lisa McHenry's Plan through PacificSource Health Plans. In addition, the court has determined that McHenry's provider Emily Hoyt, became an eligible provider under the terms of the Plan effective February 5, 2010, when she became authorized for reimbursement under Oregon Law. Bryan Denson of The Oregonian said the ruling "hailed as breakthrough for insurance coverage of special therapy," in his September 28 story on the case.

http://www.oregonlive.com/happy-valley/index.ssf/2010/09/court_ruling_in_autism_case_hailed_as_breakthrough_for_insurance_coverage_of_special_therapy.html

McHenry is a participant in the Metro Area Collection Service, Inc. Group Health/Dental Plan which is insured by defendant, PacificSource Health Plans. McHenry’s minor son was diagnosed with autism in May 2006, at the age of one year and nine months. On or about November 20, 2006, McHenry's pediatrician submitted to PacificSource a request for coverage for Applied Behavioral Analysis “ABA” therapy. In January 2007, McHenry's son began receiving ABA therapy from Emily Hoyt, BCBA, Board Certified Behavior Analyst.

McHenry submitted invoices to PacificSource for payment of services provided to McHenry's son from January through April 2007. In June 2007, PacificSource, as claims administrator, denied payment of these billings for the first time, explaining that the “provider is not eligible on this plan.” For the next several months, McHenry submitted numerous appeals and supporting documentation and each time was denied coverage. In May 0f 2008, after exhausting her remedies with PacificSource, McHenry filed a lawsuit against PacificSource Health Plans, under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 USC §§ 1001-1461, to compel coverage.

In a September 30 interview with Kerry Tomlinson, KATU Channel 2 News, the attorney for the family, Megan Glor, says "This may be the first time a court has ruled that the special treatment is medically necessary for children with autism."

In the September 28 article written by Bryan Denson of The Oregon, McHenry said " This is huge for Oregon, this is huge for our family."

Oregon autism insurance     oregon autism insurance bill     oregon autism insurance reform     oregon autism insurance states  Autism     Autism Insurance     autism Oregon     insurance     Lisa McHenry     Oregon autism insurance     PacificSource Health Plans