D.F. et. al v. Washington State Health Care Authority (WHCA) is a class action lawsuit filed in 2010 by families whose disabled children have been denied behavioral therapies by the Health Care Authority’s self-funded insurance plans.
Although a class had been certified in this case since Sept. 29th, 2011, no notice has been sent to class members about the case, the upcoming trial nor their right to opt-out. Class Notice (click to see the full notice) will be going out to all enrollees in the HCA self-funded plans since January 1, 2006 who are or have dependents who submitted health care claims with the DSM 299 diagnostic codes before trial so they can opt out. A copy of the Court Approved Notice is attached. The deadline for opting out of the Class is April 2nd, 2012.
Enrollees who stay in the Class can help the attorneys representing the class by providing evidence of denials of ABA therapy by UMP/Regence, UMR and/or Aetna Public Employee Plan, their damages, and any appeals undertaken by enrollees. If class members need help filing appeals, they may request assistance from the attorneys representing the Class.
If you are in the Class and interested in helping or want assistance with filing an appeal, please contact Eleanor Hamburger at Sirianni Youtz Spoonemore, by telephone (206) 223-0303 or via email: firstname.lastname@example.org. If, at first, you do not get a response, please try again, as the attorneys expect a high response to this email and the class notice and it may take some time for them to respond to all calls.
In addition, the court ruled imposing the provision “Applied Behavioral Analysis based interventions not using either the UCLA/Lovaas model or Early Start Denver Model (ESDM) within an investigational setting meeting the criteria” is inconsistent with the Mental Health Parity Act and the court’s landmark June 7th, 2011 decision. This means that the coverage conditions recommended by the Health Care Authority’s Health Technology Clinic Committee that would have excluded most coverage of ABA therapy is invalid.
If you believe to be a likely class members, state employees who have dependents with ASD’s and have not received notice about the class action please contact:
SIRIANNI YOUTZ SPOONEMORE
Tel. (206) 223-0303
Fax (206) 223-0246
Thank you for your consideration,