Raytheon Company, Raytheon Health Benefits Plan, and the plan’s administrator have been named in a proposed class action lawsuit in which two parents allege the parties unlawfully denied coverage for their autistic son’s speech therapy. According to the suit, Raytheon’s benefits plan applies a blanket exclusion for “non-restorative speech therapy,” which the plaintiffs argue unfairly restricts mental health coverage in violation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Parity Act).
The lawsuit explains that under the Parity Act, benefits plans that provide mental health coverage must ensure that limitations on such are “no more restrictive” than those applied to medical and surgical benefits. Raytheon, however, has allegedly excluded from its covered health benefits “non-restorative speech therapy,” “non-restorative ABA speech therapy,” and “habilitation services,” which the case argues affects only mental health treatment. The suit adds that despite these three exclusions, Raytheon does offer coverage for speech therapy related to medical or surgical procedures, such as when a plan participant or beneficiary suffers a stroke or physical injury.
The plaintiffs claim that although the defendants have never argued that speech therapy for their son’s autism spectrum disorder (ASD) was not medically necessary, the companies denied their claim for coverage based solely on the determination that the therapy was “non-restorative.” In other words, the suit says, Raytheon only covers speech therapy “to restore speech that was lost,” not speech that the company determines was not “previously intact,” regardless of whether the therapy is medically necessary. The case argues that the plan’s exclusion disproportionately restricts coverage for mental health treatment while providing “the same service” for those with non-mental health conditions.
“Based upon the plain language of the Plan document and [the plaintiffs’ son’s] administrative records, the only services that are subject to the Plan’s ‘non-restorative’ exclusions are services that are used to treat developmental mental health conditions, such as ASD,” the complaint alleges.
The plaintiffs claim that they and other similarly situated individuals have been forced to pay out of pocket for medically necessary speech therapy or “face the imminent threat that they will have to do so in the near future.” Others have been forced to forgo treatment altogether due to the defendants’ allegedly unlawful exclusions, the suit says.
The lawsuit proposes to cover a class of participants or beneficiaries under the Raytheon Health Benefit Plan that was in effect or renewed after January 24, 2014 and who “have received, require, or are expected to require services for the treatment of a qualified mental health condition” that is excluded under the plan’s “non-restorative speech therapy,” “non-restorative ABA therapy” or “habilitative services” exclusions.