Law Street Media

Lawsuit Seeks Insurance Coverage of Medical Marijuana in NM

A perosn in a labcoat's hands holding cannabis plants.

Woman hands in white coat and blue medical gloves holding green branch cannabis with five fingers leaves, marijuana for legalization medical oil hemp

Medical marijuana dispensary New Mexico Top Organics – Ultra Health, Inc. and several medicinal marijuana users filed a complaint in the Second Judicial District of the State of New Mexico, County of Bernalillo, on Friday, against numerous New Mexican healthcare corporations including Blue Cross, Cigna, Molina Healthcare, Presbyterian Insurance and Western Sky Community Care for not covering the cost of medicinal marijuana for patients with PTSD and other behavioral/mental health conditionals as required under New Mexico law.

The New Mexico Court of Appeals and Medical Cannabis Advisory Committee determined that smoking medicinal marijuana is an “appropriate service” to treat PTSD. As of January 1, 2022, healthcare providers, and Medicaid, are required to cover 100% of the cost of medicinal cannabis for people with certain behavioral conditions, including PTSD. Under the Lynn and Erin Compassionate Use Act (LECUA), medical cannabis has proven to be very effective in reducing the symptoms of PTSD and other behavioral disorders, according to numerous scientific studies that the plaintiffs cited. 

Ultra Health is suing to establish legal precedents for numerous questions that surround this issue: whether medical cannabis is a behavioral health service under New Mexico law, and whether it is a behavioral health service to all of the defendants, if the defendants covered 100% of the costs or not, and whether or not the defendants violated LECUA.

According to the complaint, these healthcare providers did not provide any financial assistance for their customers to purchase medicinal marijuana, let alone the entirety of the cost. As a result, Ultra Health and the putative class are suing on the counts of violation of state law, breach of contract, breach of covenant of good faith and fair dealing, unfair practices act, insurance code trade practices and fraud, unjust enrichment, and declaratory judgment.

The plaintiffs seek class certification, a declaration that medicinal marijuana is a behavioral/mental health service and that it should be covered by New Mexican health policies, damages, punitive damages, attorney’s fees and costs, and other relief.

Ultra Health is represented by SaucedoChavez P.C.

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