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Renaker Hasselman Sues Aetna Over Arbitrary Cap on Autism Treatment

July 22, 2015 by Margo Hasselman Greenough

The firm, along with co-counsel, filed a proposed class action against Aetna Health Inc. and a California affiliate to eliminate Aetna’s arbitrary cap on treatment for autism spectrum disorders. Plaintiff Anna M. Sanzone-Ortiz, who has employer-sponsored health insurance for herself and her family through Aetna Health of California Inc., says that her son’s health provider recommended 36 hours per week of Applied Behavioral Analysis to treat his autism, but Aetna’s policies limit the benefit to 20 hours per week. Renaker Hasselman LLP represents Sanzone-Ortiz along with co-counsel Jordan M. Lewis of Kelly Uustal, PLC in Fort Lauderdale, FL. The suit alleges that the 20-hour cap violates the Employee Retirement Income Security Act and the California Mental Health Parity Act. As Lewis said to news sources, ““[Applied behavior analysis] is generally considered the gold standard for treating autism…We believe Anna and others like her should have a fair shot at a real decision as to what sort of hours per week are appropriate, instead of having what we think is an arbitrary cap.” Medical literature suggests no less than 30 hours of treatment per week for individuals with autism. Sanzone-Ortiz seeks an order requiring Aetna to cover medically necessary ABA treatment regardless of the 20-hour cap and compensation for out-of-pocket expenses incurred due to the cap. Further coverage of the litigation appears here.

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