Anthem Sued in Georgia for Denying “Medically Necessary” Inpatient Treatment

A lawsuit was filed against Anthem Blue Cross Blue Shield for denial of mental health care on Tuesday, after the insurer reportedly approved coverage for only 40 days of treatment at a licensed residential mental health treatment center, while denying to cover the rest of the allegedly needed treatment.

The complaint recounted years of mental health issues and treatments for the plaintiff’s child, who is not party to the suit. The anonymous plaintiff explained that after years of mental health treatment options, including therapy, prescriptions, and outpatient treatment, the patient was referred to Fulshear Ranch Academy.

In denying the treatment coverage beyond 40 days, as well as subsequent appeals, the plaintiff alleged that the insurer “used ‘level of care guidelines’ that are unfair and biased against approving claims for residential treatment such as are at issue herein, and that do not reflect reasonable standards in the medical community.”

The plaintiff has sued for both recovery of benefits and breach of fiduciary duty, with both charges originating under the Employee Retirement and Income Security Act (ERISA). In the allegations, the plaintiff claimed that “Anthem profited by denying valid medically necessary claims for treatment that it would have otherwise been required to pay.”

The plaintiff is represented by DL Law Group.