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In Jessica U. v. Health Care Service Corp., a Montana district court held that an ERISA plan administrator improperly denied benefits for mental health residential treatment based solely on so-called Milliman Care Guidelines that were not included in the plan documents. The Milliman Care Guidelines ( MCG ) are a set of health industry best practices, guidelines and diagnostic criteria published by MCG Health for providers and health plans. Although the MCG are widely used by health care professionals, the Jessica U. case illustrates that plan administrators must use caution when relying on the guidelines, or other materials outside of the plan, as grounds to deny health benefits. ....
Aetna Agrees to Expand Coverage for Gender-Affirming Surgeries nytimes.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from nytimes.com Daily Mail and Mail on Sunday newspapers.
Trans women persuade Aetna to expand insurance coverage chicagotribune.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from chicagotribune.com Daily Mail and Mail on Sunday newspapers.
Aetna Agrees to Expand Coverage for Gender-Affirming Surgeries One of the nation’s largest health insurers is agreeing to pay for breast augmentation for some trans women. Two years ago, Cora Brna, a health care worker in Pittsburgh, was devastated to learn that her insurance would not cover the breast augmentation she had planned to have along with a genital reassignment surgery.Credit.Sarah Huny Young for The New York Times Jan. 26, 2021 Allison Escolastico, a 30-year-old transgender woman, has wanted breast augmentation surgery for a decade. By 2019, she finally thought her insurance company, Aetna, would pay for it, only to find that it considered the procedure cosmetic, not medically necessary, and refused to cover it. ....
After advocacy by transgender women, Aetna agrees to expand insurance coverage for gender-affirming surgeries sun-sentinel.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from sun-sentinel.com Daily Mail and Mail on Sunday newspapers.