HARRISBURG, Pa. (Legal Newsline) -- The Pennsylvania Supreme Court last week agreed to take up a case over insurance coverage for in-school autism care.
In Burke v. Independence Blue Cross, the family of a six-year-old autistic boy sued their insurance carrier, which denied the family's request for services -- known as applied behavioral analysis -- at the boy's elementary school.
Autism is a complex disorder of brain development. It is characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication, and repetitive behaviors.
The requested treatments, in this case, are recognized within the medical community as invaluable to an autistic child's social acclimation, especially when diagnosed and prescribed at an early age.
However, IBC not only claimed that the services were excluded but also challenged the authority of Pennsylvania's Autism Coverage Law, also known as Act 62. The law requires many private health insurance companies to cover diagnoses and treatment of autism for children and adolescents.
A Philadelphia Common Pleas Court judge sided with the Burkes in July 2011.
However, the state's Superior Court later determined that only insurers could bring court appeals over decisions made by an independent reviewer.
The state's high court, in granting a petition for allowance of appeal Thursday, said it would clarify whether families can appeal an insurer's denial of coverage.
According to the court's single-page order, the issue is: "Did the Pennsylvania General Assembly intend to deprive families of children with autism of the right to appeal insurance denials to court while granting that right to insurance companies?"
From Legal Newsline: Reach Jessica Karmasek by email at jessica@legalnewsline.com.