By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On July 20, 2018, a Massachusetts federal judge allowed a woman to move forward with a proposed class action against Harvard Pilgrim Health Care Insurance Company (Harvard Pilgrim). The woman is claiming that Harvard Pilgrim, which covers medical expenses at nursing homes, must also cover mental health care at her son’s behavior-correcting summer camp.
Mental Health Parity Act.
U.S. District Judge Denise J. Casper denied a motion to dismiss from the insurer, saying that the plaintiff adequately equated the two types of health settings in a lawsuit. In the suit, the insurer is accused of violating the Mental Health Parity Act when it denied coverage for behavioral services at wilderness programs. Its blanket exclusion for services rendered at wilderness treatment programs is a separate treatment limitation applicable only to mental health benefits and thus violative of the Parity Act.
The statute generally requires insurers to cover mental health treatments on the same terms that they cover medical and surgical care. As a result of this violation, the plaintiff was forced to pay more than $16,000 out of pocket for her teenage son, the lawsuit alleges.
Click here to view the complaint in full.
The Defendant’s Arguments.
In response, Harvard Pilgrim argued that it excludes wilderness-like medical benefits such as diabetes camps, so excluding wilderness mental health care is not differential. In addition, in court documents it insisted that the correct comparison was whether both types of treatment, physical and cognitive, would be excluded if offered through a wilderness program.
Despite the arguments, Judge Casper stated that the First Circuit has held that a plan administrator, in terminating or denying benefits, may not rely on a theory for its termination or denial that it did not communicate to the insured prior to litigation. To read Judge Casper’s order in full, click here.
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Sources:
Wille, Jacklyn. “Harvard Pilgrim Sued Over Wilderness Therapy Coverage.” Bloomberg Law. (July 24, 2018). Web.
Noon, Alison. “Harvard Pilgrim Must Face Mental Health Discrimination Suit.” Law360. (July 24, 2018). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawfirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone; (407) 331-6620.
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