Tufts settles autism therapy case with AG Healey
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Attorney General Maura Healey settled a case with Tufts Associated Health Plans recently.
Tufts Associated Health Plans agreed to a settlement with Attorney General Maura Healey's office to resolve allegations that the insurer violated the state's consumer protection and mental health parity laws by restricting coverage to children for therapies related to the treatment of autism.
The health plan, as part of the terms of the settlement announced Wednesday by Healey, agreed to reimburse patients who paid out-of-pocket and providers who refunded payments received from Tufts for applied behavioral analysis therapy for autism. Tufts also agreed to pay $90,000 to the state, including $5,000 in civil penalities, $20,000 in attorneys fees and $65,000 that will be used for programs to improve care and treatment of autism.
“We can’t treat patients with behavioral health issues, including autism, differently from those with physical conditions,” Healey said in a statement. “Together, we need to break down the barriers that for too long have made the treatment of behavioral health secondary in our health care system. We appreciate that Tufts will take these actions to help ensure access to behavioral health treatment.”
The attorney general alleged that Tufts Health Plans violated the state's autism insurance, mental health parity and consumer protection laws by requiring parental presence at every behavioral analysis appointment to obtain coverage and by prohibiting coverage for therapy provided in daycare and preschool settings.
In the settlement filed in Suffolk Superior Court on Tuesday, Tufts stipulated that it would revise its policies to no longer require parental presence for coverage and to allow coverage for treatment in daycare and preschool settings.
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