Complaint Claims Minor Child’s In-Patient Treatment Should Be Covered By Insurance

In May, Bea S., legal guardian of the minor child J.S., filed a lawsuit against Anthem Blue Cross, a healthcare provider, on behalf of the child in the superior court of California. In the lawsuit, the plaintiff accused Anthem Blue Cross of breach of contract, insurance bad faith, and violating the California Mental Health Parity Act. The health insurance company moved the lawsuit to the California Northern District on Thursday.

According to the lawsuit, J.S. has a health care plan that guarantees coverage for inpatient and outpatient mental health treatment. J.S. saw a psychiatrist beginning when he was 12, where he was diagnosed with ADHD and was given weekly therapy and medication as a remedy. J.S. also suffered from major depressive disorder, parent child relationship problems, and anxiety as he grew older. Eventually he began displaying depressive and suicidal behavior, which he vocalized to his parents.

His behavior worsened as he grew older and eventually, the minor child started selling drugs and was expelled from his school. Upon transferring, he began self harming and starting fires in his home and other places. At this point his parents felt that he was a danger to himself and others and that these issues could no longer be resolved in an outpatient setting so they decided to admit him to Second Nature care facility under advisement from the child’s doctor and psychiatrist. 

Based on their plan, the plaintiff believed that the expenses of this inpatient treatment would be covered by insurance. Plaintiff filed a claim with Anthem to cover the cost of the mental health treatment but was denied coverage. After appealing the decision multiple times, the plaintiff had not made any progress in getting coverage and was still on the hook for the medical bills associated with the treatment. A few more appeals produced similar results. 

The plaintiff believes that the defendant was unreasonable in their decision in light of the “obvious medical necessity” in the situation, and claimed that the plan was supposed to cover these expenses. As a result the plaintiff has incurred hefty medical bills which they have been paying  for from their own pocket. Through the complaint, the plaintiff is seeking monetary compensation for these expenses.

The plaintiff is represented by DL law group. Anthem Blue Cross is represented by Hinshaw & Culbertson.