In a Northern District of California complaint filed Tuesday, a employee of defense company Northrop Grumman alleged that the health plan provided by his employer and administered by Anthem fell short of the requirements of the Employee Retirement Income Security Act.
The plaintiff argued that ERISA required Anthem to approve coverage of his son’s mental health treatment, as the treatment was medically necessary. The complaint recounted the son’s long-term mental health treatment was deemed necessary “based upon the reasoned medical opinions of N.H.’s mental health providers.” Anthem initially approved coverage of the treatment, but retracted the approval after two months; the plaintiff explained that the long-term in-treatment care like that required by the plaintiff’s son often lasts between six and 18 months.
The plaintiff said they appealed the decision, but to no avail, and have thus exhausted their remedies. They are represented by the DL Law Group.