Aetna Sued After Denying Residential Treatment

On Friday a case was filed in the Northern District of California by a beneficiary against Aetna Life Insurance and Playworks Education Welfare Benefits Plan. The case is regarding improper denial of mental health benefits under ERISA.

Health plans governed by ERISA are required to meet the requirements of the Mental Health Parity and Addiction Equity Act. This includes a requirement to provide coverage for mental health treatment to the same degree as is provided for medical treatment and not to impose a higher standard for mental health treatment beyond that imposed for medical.

The plaintiff’s minor child was suffering under several medical comorbidities, including suicidal ideation, violence, and depression, the complaint said. The minor received increasing levels of care which were ineffective in curbing the issues until residential treatment was indicated, according to the plaintiff.

Aetna covered the initial treatment for 6 weeks to cover the initial crises, but denied further treatment, the complaint said. The plaintiff argues that Aetna violated the MHPAEA by not covering chronic treatment for Mental Health cases at the level of care proved effective for that patient, as well as not applying sensible rules regarding comorbidities as it applies in medical cases.

The plaintiff is suing for recovery of benefits and breach of fiduciary duty. The plaintiff is represented by DL Law Group.