September 28, 2021

Paul Kinne Files Class Action Lawsuit Against Group Health Cooperative After Their Refusal to Cover Applied Behavior Analysis Treatment for Autism Spectrum Disorder

Gingras, Thomsen & Wachs partner Paul Kinne has filed a class action lawsuit in the Western District of Wisconsin on behalf of Angela Midthun-Hensen and Tony Hensen, as the representatives of their minor daughter, K.H., and on behalf of all others similarly situated.

The complaint states that Group Health Cooperative of South Central Wisconsin, Inc. (GHC) violated the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act when they denied coverage for Applied Behavioral Analysis (ABA) as a treatment to improve K.H.’s Autism Spectrum Disorder (ASD).

“The days of disregarding the needs of disabled children should be in the distant past,” said Paul Kinne. “These families face extra challenges in their day-to-day lives. Expecting them to pay for care that was covered under their health insurance policies is inexcusable.”

ASD impacts the lives of one in 40 children between the ages of three and 17 in the United States. There is no cure for ASD, but the condition can be treated so that autistic individuals can better manage their symptoms.

Health care providers frequently recommend Applied Behavior Analysis for autistic children because it has been proven effective. Speech therapy and occupational therapy are key components of ABA.

Under the recommendation of her healthcare providers, K.H. received ABA and made great progress. However, K.H.’s health insurance company, Group Health Cooperative, denied coverage for ABA treatment, including speech and occupational therapy.

GHC stated its reason for denial was that speech therapy is not an evidence-based treatment for the core deficits of ASD for children ages 10 and above. It also issued a decision denying coverage of occupational therapy, stating that it was considered experimental and investigational because it is not an evidence-based treatment for autism.

This denial of coverage forced K.H.’s parents to pay out of pocket for the therapy, despite the fact that they had been paying insurance premiums to GHC to cover K.H.’s care.

K.H.’s family is not alone. That is why Gingras, Thomsen & Wachs is standing up for K.H. and all children like her in Wisconsin by filing a class action lawsuit.

The lawsuit asks GHC to put people before profits and live up to its promise to pay for proven, effective therapy that makes K.H.’s life better — as well as the lives of so many other children. K.H.’s family is seeking reimbursement for out-of-pocket expenses they incurred that GHC should have ultimately paid.

Our Gingras, Thomsen & Wachs team hopes that GHC will do the right thing and compensate the Hensen family along with the other families who were unfairly compelled to pay for therapy in spite of GHC’s promise to cover the care.

Read the full complaint here.

Current News Coverage:

https://www.wpr.org/dane-county-family-sues-health-insurer-not-covering-daughters-treatment-autism

https://madison.com/wsj/news/local/health-med-fit/dane-county-family-sues-ghc-over-denial-of-services-for-autism/article_44619040-6b67-554b-9e30-a5c88c6e3c49.html