On Friday, a case was filed in the District of Utah by an insured who was a member of an employer funded ERISA health plan against Anthem Blue Cross Blue Shield over an alleged failure to cover mental health related treatment.
The patient, the complaint said, was a minor child who received benefits through their adoptive parents’ ERISA employer plan. The patient was said to have exhibited several severe mental health issues, including suicidal behavior, and was admitted on four separate occasions to three different mental health treatment centers.
All four of these stays were denied by Anthem as noncovered under two different reasonings, the complaint said. First, the insurer alleged that the facilities were not accredited by Commission on Accreditation of Rehabilitation Facilities and was only accredited under the Utah State Commission on Rehabilitation Facilities.
The filing said the second denial concerned the type of treatment offered by the centers, citing an exclusion on the policy for wilderness therapy or residential school based treatments. The plaintiff argued that both denial reasons ran contrary to the Mental Health Parity and Addiction Equity Act (MHPAEA), which requires that health plans not hold mental health coverage to a higher standard or more requirements than medical coverage would have required.
The plaintiff is suing for recovery of benefits and for violation of the MHPAEA in requiring the higher level certification. The plaintiff is represented by the law firm of Brian S King.