Are school districts or insurance carriers responsible to pay for autistic students to receive services and treatment in a school setting?

Both- according to a recent Philadelphia Court of Common Pleas decision.

Judge Fox ,in the case of Anthony Burke v. Independence Blue Cross,  ruled that the PA Autism Insurance Act ("Act 62"), which went into effect on January 1, 2010, requires that if an insurance carrier chooses to cover a type of treatment or service for any other condition, then it must also cover that treatment or service for autism service disorders regardless of setting.  Meaning, even if a health insurance policy otherwise excludes services in schools, Act 62 overrides such an exclusion because Act 62  provides that insurers must pay for rehabilitative care, including applied behavioral analysis ("ABA").  While Judge Fox noted the overlap between IDEA and Act 62, he ultimately decided that the legislature, by creating overlapping statutes, purposely chose to pass some of the cost of ABA services to insurance carriers.  Of course the decision in Burke has no relevance when Act 62 does not apply, such as in the case of self funded healthcare programs. 


Not surprisingly, Independence Blue Cross filed their appeal on August 16, 2011. 

Trackbacks (0) Links to blogs that reference this article Trackback URL
Comments (0) Read through and enter the discussion with the form at the end
Post A Comment / Question Use this form to add a comment to this entry.

Remember personal info?
Send To A Friend Use this form to send this entry to a friend via email.