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Health your username March 8, 2021 On Friday the court issued an order denying the motion to dismiss in a case brought against Anthem BlueCross BlueShield of Wisconsin et al. The case, filed in the District of Utah, alleges that Anthem BlueCross BlueShield, in administrating the Advocate Aurora Health Care, Inc. Health and Welfare Plan was unfairly requiring higher medical standards for mental health treatment than for medical treatment in violation of the Parity Act, a subset of ERISA. The plaintiff’s son was admitted to two separate residential treatment facilities after outpatient treatment was not successful. BCBS denied the treatment as not medically necessary, stating that lower levels of care, such as an intensive outpatient program (“IOP”) or a partial hospitalization program (“PHP”), should have been tried prior to moving to a residential setting. BCBS also indicated that there was no evidence of imminent harm to justify skipping these lower leve ....
Health your username February 1, 2021 On Friday in the District of Utah, Judge Ted Stewart denied United Behavioral Health (UBH) and Motion Picture Industry Health Plan for Active Participants’ motion to dismiss a claim by individual plaintiffs that alleged that the defendants violated the Mental Health Parity and Addiction Equity Act of 2008 (Parity Act) through coverage denial. The plaintiffs, a parent and a dependent, stated that UBH denied coverage of the dependent’s residential therapy treatment at Evoke Wilderness Program. The company claimed such programs are “experimental and unproven” and that the dependent was “not at risk,” of self-harm or harm to others, “was medically stable, was not experiencing withdrawal symptoms, was not under the care of a psychiatrist, and did not require 24-hour medical or psychiatric care,” the court explained. After the wilderness program, the dependent was admitted to Catalyst Residential Treatment, which the ....