On Wednesday a case was filed in the Northern District of California, as a Jane Doe action against Apple Inc. Health and Welfare Benefit Plan. The case is regarding coverage of mental health benefits under the Mental Health Parity and Addiction Equity Act (MHPAEA).
MHPAEA requires coverage of mental health and addiction treatment charges at the same rates and levels as medical coverage under ERISA health plans. According to the complaint, the plaintiff is a minor beneficiary of the defendant ERISA health plan for Apple Inc.
The plaintiff said they suffered from depression and suicidal ideation and required inpatient level treatment following a suicide attempt. The plaintiff sought authorization for treatment at Avalon Hills, which was the only local facility to offer the types of treatment plans recommended by her medical providers, but received a denial from United Behavioral Health as the third party administrator of the Apple Inc. Health and Welfare Benefit Plan.
Per the plaintiff, UBH offered other inpatient facilities, but those facilities did not offer the type of treatment recommended. Per the plaintiff, UBH denied the authorization without taking into account the necessity of the specific treatment as well as without acknowledging that the other facilities did not perform that treatment.
Plaintiff is suing for recovery of benefits and injunctive relief for authorization for future treatment as necessary. Plaintiff is represented by Kantor and Kantor LLP.