Zuckerman Spaeder LLP today filed a complaint in the U.S. District Court for the Northern District of California on behalf of the mother of a 13-year-old child who was denied coverage for Applied Behavioral Analysis to treat his autism. The complaint alleges that the health plan’s exclusion of ABA therapy, known widely in the medical community as the standard of care for autistic children, violates the Mental Health Parity and Addiction Equity Act of 2008, and that it was therefore illegal for United Behavioral Health to enforce the exclusion.

The federal Parity Act prevents insurance plans from imposing “treatment limitations” for behavioral services that exceed those that apply to medical/surgical treatments. As the complaint explains, while the Parity Act does not require that behavioral health be covered by a plan, when it is, it must be covered consistent with parity.

The complaint was filed by Zuckerman Spaeder partners Caroline Reynolds,Rachel Cotton, D. Brian Hufford and Jason Cowart, along with Meiram Bendat from Psych-Appeal, Inc., on behalf of an individual insured by UBH.

In this case, it has been repeatedly recommended that the plaintiff’s teenaged son, “John Doe,” receive ABA therapy for his autism spectrum disorder, given the severe difficulty he has interacting with the world around him. His aggression and violent outbursts have made it extremely difficult for his mother to provide him with safe and effective care, nor can she afford paying out of pocket. ABA therapy is proven to be effective for treating autism in children and adolescents, particularly when applied intensely for up to 40 hours each week.

Courts have already recognized that excluding coverage for ABA therapy is a Parity Act violation. One example is A.F. ex rel Legaard v. Providence Health Plan, where after the court certified a class of beneficiaries whose claims for ABA therapy were denied based on a plan exclusion, it granted plaintiff and the class summary judgment under the Parity Act. The court stated that, “By stating that it covers autism (a developmental disability), but excluding coverage for all services ‘related to a developmental disability,’ Providence is not covering treatment for mental health conditions in parity with treatment for medical conditions.”

“What’s ironic is United Behavioral Health has recognized that applied behavioral health therapy is the standard of care for autism,” said Ms. Reynolds. “It even adopted a policy in 2017 to cover ABA therapy in all of its fully-insured plans. But UBH enforces exclusions of ABA coverage in self-funded plans, which represent over 70 percent of its business. This lawsuit will show that UBH’s behavior is both illegal and irresponsible.”

“Autism is the fastest growing developmental disability, increasing up to 15 percent annually since 2002,” said Mr. Hufford. “Researchers have spent decades developing techniques that work most effectively and have discovered providing ABA therapy as early as possible is key to helping patients interact with the world. By bringing this lawsuit, we hope to eliminate the discriminatory behavior that insurers are currently getting away with, at the expense of patients’ health.”

This new lawsuit is part of Zuckerman Spaeder’s ongoing national effort on behalf of clients to hold insurance companies accountable for widespread denials of mental health and addiction treatments. The firm has developed a national practice representing patients and health care providers such as doctors, hospitals, and medical equipment companies in disputes with health insurance companies. Their groundbreaking application of ERISA and other related federal and state laws has resulted in numerous precedent-setting wins, including the landmark decision issued earlier this year in Wit, et. al. v. United Behavioral Health and Alexander, et al. v. United Behavioral Health. These lawsuits are at the vanguard of the firm’s nationwide effort on behalf of clients to force insurer compliance with their fiduciary duties under federal law.

Psych-Appeal, Inc. is a Los Angeles-based law firm exclusively dedicated to mental health insurance claims, advocating on behalf of patients, clinicians, and treatment facilities.

With more than four decades of experience managing complex, high-stakes legal disputes and investigations, Zuckerman Spaeder is considered one of the nation’s premier litigation boutiques. The firm’s highly accomplished attorneys, many of whom served as prosecutors or senior government officials, represent businesses, organizations, and individuals in white collar defense, enforcement actions, commercial disputes, health care litigation, ethics matters, class actions and more. Among the firm’s recent recognitions: National Law Journal's "Midsize Hot List”; U.S. News & World Report Best Law Firms - “Tier 1” national ranking in white collar criminal defense and regulatory enforcement; and, Law360 Benefits Practice Group of the Year. www.zuckerman.com.