News & Analysis as of

Denial of Insurance Coverage Health Insurance Mental Health

Ogletree, Deakins, Nash, Smoak & Stewart,...

Ninth Circuit Affirms ERISA Plan Administrator’s Decision, Validates Use of Industry Guidelines and Medical Evidence

On March 5, 2019, Magistrate Judge Joseph C. Spero of the U.S. District Court for the Northern District of California issued his opinion in Wit v. United Behavioral Health, in which he attempted to significantly change how...more

Arnall Golden Gregory LLP

AGG Talks: Healthcare Insights Podcast - Episode 4: What to Do When Insurance Companies Deny Behavioral Health Claims

In this episode, AGG Healthcare Litigation co-chair Jason Bring is joined by AGG Healthcare Litigation partners Rich Collins and Damon Eisenbrey to discuss what you can do when insurance companies deny behavioral health...more

ArentFox Schiff

Ninth Circuit Reissues Opinion for the Second Time in Suit Challenging United Behavioral Health’s Mental Health Coverage...

ArentFox Schiff on

Last week, the US Court of Appeals for the Ninth Circuit, in its third opinion in the case, reversed a lower court’s decision allowing patients challenging United Behavioral Health’s (UBH) internal mental health coverage...more

Proskauer - Employee Benefits & Executive...

Ninth Circuit Defers to Plan Design and Administrative Discretion on Bounds of Mental Health Coverage

A recent decision by the U.S. Court of Appeals for the Ninth Circuit (Wit et al. v. United Behavioral Health and Alexander et al. v. United Behavioral Health) exemplifies the challenge in balancing a desire to cover evolving...more

Polsinelli

Ninth Circuit Reverses Landmark Wit Case Addressing Behavioral Health Coverage

Polsinelli on

The President and his administration continue to tout their efforts to strengthen coverage for behavioral health care, including significantly increasing behavioral health spending and strengthening parity between physical...more

Husch Blackwell LLP

New York District Court: The Choice of Medical Necessity Criteria is a Fiduciary Act

Husch Blackwell LLP on

We continue to see an increase in fiduciary litigation involving employer-sponsored group health plans, particularly litigation involving mental health. A recent New York Federal District Court case, Collins et al. v....more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor – June 2021: Sparsely Pleaded Parity Act Lawsuit Survives Motion to Dismiss

In Nathan W. v. Anthem Bluecross Blueshield of Wisconsin, 2021 U.S. Dist. LEXIS 42127 (M (D. Utah Mar. 5, 2021), a federal court held that conclusory allegations of discriminatory medical necessity criteria were sufficient to...more

K&L Gates LLP

Recent District Court Decision Highlights the Importance of Adequate Behavioral Health Claims Processing Guidelines for ERISA...

K&L Gates LLP on

On this week’s episode, Carla DewBerry and Sarah Carlins discuss a recent California Federal District Court decision in David Wit v. United Behavioral Health, in which the court found that the defendant insurer violated ERISA...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor - October 2020: Insurance Coverage During Involuntary Legal Holds Under California Law

Mental health patients are sometimes hospitalized under a legal hold allowing their temporary hospitalization. Medical providers seeking payments for services provided to patients subject to a legal hold argue, in both the...more

K&L Gates LLP

Triage: Updates to Mental Health Parity in California and Nationwide

K&L Gates LLP on

In this week’s episode, Carla DewBerry and Kelsey Jernigan discuss issues in mental health parity in the context of recent California legislation. In particular, the presenters discuss how a new California bill has sparked a...more

K&L Gates LLP

K&L Gates Triage: Michael P. V. BCBS Of Texas

K&L Gates LLP on

In this week’s episode, Gary Qualls discusses a recent case decided in the Western District of Louisiana, which highlights how the application of the arbitrary and capricious standard as applied to payor coverage...more

Proskauer - Employee Benefits & Executive...

Limitation To Restorative Speech Therapy Does Not Violate MHPAEA

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...more

Foley & Lardner LLP

Behavioral Health & Substance Abuse Services: Massachusetts Proposal Reflects Focus on Expanding Access and Coverage

Foley & Lardner LLP on

... Massachusetts House Bill 4134 includes several provisions aimed at expanding access to treatment for mental health and substance use conditions in the Massachusetts Commonwealth. Most notably, the Bill would require...more

Bradley Arant Boult Cummings LLP

Could Possible Predictability Be Coming to Wilderness Therapy Coverage Disputes?

Current trends in litigation regarding wilderness therapy coverage center on motion practice. Courts have been unpredictable with granting or denying defendants’ motions to dismiss and motions for summary judgment, and recent...more

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