Update:  The settlement described below has been formally approved by the court, and is now in place.

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T-Mobile Class Action Settlement Information

Welcome to the T-Mobile class action settlement website!  This site is designed to provide you with information about a proposed settlement in a class action involving health insurance coverage for applied behavioral analysis (ABA) therapy for individuals with autism or autism spectrum disorder (ASD).

What is the lawsuit about?

The lawsuit alleges that T-Mobile's self funded health plan, which is administrated by United Healthcare, illegally excluded and/or limited coverage of medically necessary ABA therapy to treat ASD.  A copy of the Complaint is posted here.  The parties have entered into a proposed settlement agreement, which may be viewed here (with an amendment here), and are seeking approval of the settlement agreement.  If you are a member of the class, then you have certain rights in this process, including the right to claim a portion of the settlement fund if you incurred expenses for ABA when the treatment was being denied.  This process is explained below, and in the official class notice, which may be viewed here.  The forms for making a claim are attached here.

Am I a member of one of the classes?

Simply because you received a notice in the mail does not make you a class member.  You, or your dependent, must fit within the class definitions to be a class member.  If you are not a class member, then your rights are not affected and you may disregard the notice.  The class is defined as all individuals who:

(1)        (a) have been participants or beneficiaries in the [T-Mobile] Plan at any time between January 1, 2010 and the Effective Date [the date the agreement is finally approved by the court]; (b) who had an Autism diagnosis and received ABA therapy to treat Autism during the Class Period; or

(2)        who are participants or beneficiaries in the [T-Mobile] Plan and qualify for future ABA therapy to treat Autism; or

(3)        the parents and guardians of the individuals described in Section 1.22(1) or Section 1.22(2); or

(4)        the Successors-in-Interest of the individuals described in Section 1.22(1)-(3).

 You may call class counsel at 206-223-0303 if you are unsure if you are a member of the class.  You may also email class counsel at either rspoonemore@sylaw.com or ehamburger@sylaw.com.

What does the Settlement Agreement say?

Under the terms of the Settlement Agreement, T‑Mobile will provide broad prospective and retrospective relief to class members. 

With respect to prospective relief, T‑Mobile has eliminated all of its exclusions and treatment limitations on Applied Behavior Analysis (“ABA”) therapy coverage, the essential treatment for ASD, which was the subject of this case.  T‑Mobile has agreed to clinical coverage criteria which are consistent with that agreed to by the major health insurers in Washington State (Regence, Premera and Group Health), as well as Washington’s Medicaid and Public Employees health benefit plans.  Class members now have comprehensive coverage of ABA therapy to treat ASDs, and the ability to access that care.

With respect to retrospective relief, the Settlement Agreement establishes a $676,935 settlement fund to pay past claims (whether previously submitted or not) for ABA therapy, attorneys’ fees, costs and incentive awards.  Based upon the claims processes in other cases and an analysis by plaintiff’s expert, class counsel anticipates that the settlement fund will be sufficient to pay all claims at or near 100%.  

What do I need to do?

If you believe that you (or your dependent) are in the class, you should read the settlement notice.  If you have unreimbursed claims for ABA therapy from January 1, 2010 through December 31, 2014, then you should make a claim for reimbursement.  The forms to make a claim are attached here.

What are the deadlines?

If you wish to make a claim, then you must fill out the claim form and certification page and return them by December 22, 2016.  Mailing instructions are set forth on the claim form instruction page.

If you wish to comment on, support, or object to, the settlement agreement, then you must submit such material by December 22, 2016.  Instructions on how to submit comments are contained in the class notice.

The fairness hearing -- a hearing where the Court considers whether the Settlement Agreement is fair, reasonable and adequate -- is scheduled for January 5, 2017 at 10:00 a.m. at the United States Courthouse, 700 Steward Street, Suite 13206, Seattle, WA 98101.

Key Documents in the Case.

  • A copy of the Complaint is posted here.
  • The Order certifying a settlement class is here.
  • The Order preliminarily approving the Settlement Agreement is here.
  • The motion seeking certification of a settlement class is here.
  • The motion seeking preliminary approval is here.
  • The motion for fees, costs and incentive awards is here.

Questions?

If you have additional questions, please call class counsel at (206) 223-0303.  You can also email class counsel at rspoonemore@sylaw.com or ehamburger@sylaw.com.