Investigation Into Limits on Benefits for Treatment of Autism in Kentucky      

Strauss Troy is investigating potential claims against Anthem Health Plans of Kentucky, Inc., which relate to the limits it imposes on coverage for the treatment of autism in the Commonwealth of Kentucky.  The Kentucky Autism Mandate requires that every individual health insurance policy issued in Kentucky after January 1, 2011, include coverage for the treatment of autism.  The Kentucky Autism Mandate purports to limit benefits to $1,000 per month for individuals from their 1st through 21st birthday.  However, the Kentucky Mental Health Parity Act and the Federal Mental Health Parity Act prohibit health insurance plans from treating a “mental health condition” differently than a medical condition. That is, the insurance policy may not impose visit limits or dollar limits for treatment of mental health conditions that are not also imposed for medical conditions. Under both the Kentucky and Federal Mental Health Parity Acts, a “mental health condition” includes autism.

By imposing limits on treatment for autism, Anthem may have violated both the Kentucky and Federal Parity Acts.  If you have a child with autism and an individual health insurance policy issued by Anthem, your benefits for the treatment of autism may have been limited to a certain number of hours each month or may have been limited to $1,000 each month.  If this happened to you, we would like to speak to you.

For more information, please contact Robert Sparks at Strauss Troy at 513.629.9417 or rrsparks@strausstroy.com.

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