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State, Providence settle case involving autism treatment claims

August 24, 2017


Salem — The Oregon Department of Consumer and Business Services (DCBS) and Providence Health Plan have reached agreement on the insurer’s process for adjudicating autism treatment claims in 2012.

As part of the agreement, Providence will pay the state $100,000 in civil penalties.

The claims were filed by autistic patients who were receiving Applied Behavior Analysis (ABA) therapy. Their claims were denied under an exclusion that did not give them the opportunity to appeal to an outside review organization.

“At the time these claims were filed, there was still debate over whether ABA therapy was the most effective treatment for autistic patients,” said Laura Cali Robison, Oregon insurance commissioner and administrator of the DCBS Division of Financial Regulation. “We found that Providence Health Plan’s adjudication process at that time did not give consumers an opportunity to externally appeal payment or denial decisions.”

To read the order, click here: http://dfr.oregon.gov/AdminOrders/enf-orders-2017/Consent%20Order%20ssig.pdf

Consumers who have issues or questions about coverage of mental health treatments claims or any other insurance issue should contact the DCBS Division of Financial Regulation at 1-888-877-4894 (toll-free) or email cp.ins@state.or.us.

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The Division of Financial Regulation is part of the Department of Consumer and Business Services, Oregon's largest business regulatory and consumer protection agency. Visit dcbs.oregon.gov and dfr.oregon.gov.

Press questions

Brad Hilliard
503-947-7873
brad.hilliard@oregon.gov

Mark Peterson
503-947-7868
mark.peterson@oregon.gov​​​​​​​​​​​

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