D. Brian Hufford, ofZuckerman Spaeder in New York City
A federal trial judge has certified a class action filed againstBlue Shield of California and Magellan Health Inc. forsystematically restricting insurance coverage for mental health andsubstance abuse treatment.
In her June 15 order, U.S. District Judge Lucy Koh of theNorthern District of California granted class certification forEmployment Retirement Income Security Act group plan members whoseclaims for residential and intensive outpatient mental health andsubstance abuse treatment were rejected by insurer Blue Shield andhealth care provider Magellan based on the companies' medicalnecessity criteria guidelines from Jan. 1, 2012, to thepresent.
It's the latest victory in a niche market dominated by a handfulof health care plaintiffs lawyers who go after insurers fordisparate treatment of behavioral health issues in violation ofERISA and depending on the case, the Mental Health Parity andAddiction Equity Act of 2008.
This most recent suit alleges that the criteria Blue Shield andMagellan used to restrict coverage for this type of care areinconsistent with the terms of the relevant insurance plans andgenerally accepted professional standards in the mental health andsubstance abuse disorder treatment community.
Magellan declined to comment on the case. A Blue Shieldspokesman declined to comment on the specifics of the pendinglitigation but said that, We disagree with the allegations in thelawsuit and the court's certification of a class in this case. Weintend to continue to defend the case vigorously.
Another class action that was certified by a federal judge in Connecticut lastmonth alleges Aetna Inc. systematically denied insurance coveragefor transcranial magnetic stimulation to treat severedepression.
Representing the plaintiffs in both cases are Zuckerman Spaederand Psych-Appeal Inc., a West Hollywood, California, law firmdevoted to mental health insurance law. The two firms havesuccessfully collaborated on around six cases of this kind sincethey teamed up a few years ago. LeClairRyan is co-counsel in theAetna case, and Grant & Eisenhofer is co-counsel in the BlueShield and Magellan matter.
Meiram Bendat.
The cases have been successful because they speak to systematicabuses that are relatable, and the remedies we are seeking are justintrinsically fair, said Meiram Bendat, president of Psych-Appeal,who is both a psychotherapist and a lawyer. They're requiring theinsurers to essentially conform their practices to the properstandard of care.