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A.F., et al. vs. Providence Health Plan

Keith Dubanevich and Josh Ross represented children with autism in a class action against Providence Health Plan. The lawsuit alleged that Providence wrongfully denied claims for reimbursement of expenses related to Applied Behavioral Analysis therapy (“ABA”). A federal judge approved the case as a class action and then ruled that Providence’s behavior violated both federal and state law. Shortly thereafter, the Oregon Insurance Division wrote bulletins requiring coverage of ABA. As a result, health insurance companies in Oregon and large corporations with self-insured plans began covering ABA for their employees. After years of litigation, the Court approved a settlement under which Providence agreed to never use the Developmental Disability Exclusion to deny coverage of ABA, paid a confidential sum to the families that led the case, and paid attorneys’ fees.