United Agrees To Cover Speech Therapy
The Department of Managed Health Care announced earlier this week that it has come to terms with two subsidiaries of insurance giant United HealthCare regarding their failure to provide speech therapy coverage to its enrollees.
The DMHC reached a settlement on Aug. 12 with United HealthCare of California and U.S. Behavioral Health Plan after a survey by the agency detected a failure to provide coverage to enrollees, primarily children who required speech therapy as the result of a mental illness such as autism or other emotional disturbances. It went into effect on Aug. 23.
United HealthCare had claimed that the services fall under educational services and were not included in its coverage – a stance the DMHC insisted violated the Knox-Keene Act because such services are considered medically necessary treatments.
Although United did not admit wrongdoing as part of the agreement, it will reimburse costs for any enrollee who paid for speech therapy services out of their own pocket between May 2011 and this month, minus any previously agreed-to cost-sharing that is part of their policy.
Enrollees can apply for reimbursement through July 2014.
United also agreed to notify its membership by newsletter by this November. The DMHC will approve the content of the notice prior to it being mailed out, according to the agreement.
The health plan also reserves the right to perform periodic reviews of the services enrollees receive, but may not interrupt them during the review period.
If the enrollee has been diagnosed with autism or a pervasive developmental disorder, it may only conduct such reviews every six months.
“The agreement ensures that UHC enrollees needing speech therapy will receive the care to which they are entitled to under the law,” said DMHC Director Brent Barnhart. “Enrollees will no longer have to pay out of pocket to receive medically necessary speech therapy services and can now seek reimbursement for past out-of -pocket expenses.”
United HealthCare did not admit any wrongdoing as part of the settlement, nor did it pay a fine.
“While we believe UnitedHealthcare’s policy to provide these services to our members was appropriate, we feel it was important to resolve this dispute and reach agreement with the DMHC,” the Minnesota-based insurer said in a statement. “We are pleased to resolve this old issue and look forward to continuing to provide our members with the highest level of service.”
The DMHC tangled with Kaiser Foundation Health Plan regarding the medical necessity of speech therapy last year.
Kaiser had declined coverage to patients whose speech issues were not connected to physical conditions.
As a result, the DMHC ordered the Oakland-based insurer to provide the coverage. Unlike United, Kaiser did not enter into a formal settlement with the agency.
