Limitation To Restorative Speech Therapy Does Not Violate MHPAEA

Proskauer - Employee Benefits & Executive Compensation Blog

A federal district court in Massachusetts concluded that a health insurance plan did not violate the Mental Health Parity and Addiction Equity Act by denying coverage for speech therapy to a plan beneficiary who required speech therapy in connection with autism spectrum disorder.  The plan denied coverage because the speech therapy sought was for non-restorative speech therapy, and the plan only covered restorative speech therapy.  The district court concluded that the exclusion on its face did not purport to address only mental health benefits and, in fact, the exclusion evinced no differentiation between mental health benefits and medical/surgical benefits given that the exclusion limited coverage for all speech therapy that is restorative, i.e., intended to regain a level of speech that was previously intact.  The case is N.R. v. Raytheon Co., No. 20-cv-10153 (D. Mass. June 9, 2020).

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