Family says autistic son denied benefits covered by law, sues

Family says autistic son denied benefits covered by law, sues »Play Video
Lucy Alonso is suing Providence Health Insurance because she says her autistic son is being denied treatments guaranteed by law.

PORTLAND, Ore. – The family of an autistic boy is taking Providence Health Insurance to federal court, claiming their son has been denied treatments guaranteed by law.

The family has filed a class-action lawsuit, saying the insurance company should pay for what's become standard but expensive treatment for autism.

Lucy Alonso's been struggling just to pay for some treatments for her son's autism, but she can't afford much.

The federal class-action lawsuit says this is just the kind of treatment federal regulations and state law require insurance companies to cover.

When her son was just two years old, Alonso already knew something was wrong. During the last in a series of evaluations, she kept thinking her son had autism.

"So after 20 minutes of the interview, I said, 'Does he have autism?' And you know, the two women who came out to the house looked at each other and it was just kind of like all I needed. And they said, 'yeah.'"

Children with autism need intensive and costly therapy known as "applied behavioral analysis" just to have a chance at a normal life.

"Financially, it's impossible to be able to meet the 30 to 40 hours a week. For us, it's impossible," Alonso said.

When Alonso put in for insurance reimbursement from Providence Health Plans, it denied her claim.

"You know, I lost my faith pretty quickly with the whole medical field," Alonso said. "Again, waiting six to eight months to have your son evaluated was just ridiculous to me. And you know, Providence kept denying us about everything our doctor recommended."

Providence didn't want to comment on this story.

Alonso and her husband gave up their home trying to pay for her son's therapy.

Now the family is one of two suing Providence in federal court, claiming state and federal insurance laws require Providence to pay for the kind of treatment Alonso’s son's autism needs.

"I'm not going to be here forever to help him," Alonso said. "So I know that the earlier the intervention, the better results we can get."

She knows those chances are slipping away day by day.

A federal judge will decide the case, possibly by the end of the year.

The attorney representing the Alonsos says the case could set an insurance-coverage precedent for the families of about 8,000 children across Oregon diagnosed with autism.

He says Kaiser Permanente changed its polices within the past couple of months to cover those autism treatments.