Father Claims Blue Cross Blue Shield Should Cover Minor’s Residential Treatment School

On Tuesday a case was filed in the Utah District Court by a father on behalf of his minor child against Blue Cross Blue Shield of Rhode Island as the third party administrator for their insurance plan. The case addressed the processing of mental health related claims on behalf of the minor child and the alleged breach of ERISA statutory provisions in this processing.

The minor child allegedly received severe neglect during her infancy in an orphanage prior to her adoption. After this, the patient began behaving erratically, showing signs of extreme anxiety and inability to function in normal life, self care situations, and social situations such as school. This difficulty resulted in the father seeking a residential placement for the minor child which permitted treatment while still allowing the patient to maintain educational progress. 

While acknowledging that the severity of the patient’s condition required an inpatient treatment environment, BCBS of RI reportedly denied coverage for her placement in a residential treatment school environment. Instead the defendant indicated that the patient should have been treated, then released to a routine school environment, despite the accreditation of the residential treatment school. 

The insureds appealed the decision with medical records showing that the option BCBS of RI had preferred had been tried and failed, as well as the success of the residential treatment school the minor child had attended. However, the complaint alleged, BCBS arbitrarily maintained its decision, contrary to the Mental Health Parity and Addiction Equity Act.

The plaintiff is suing for Recovery of Benefits Under 29 U.S.C. §1132(a)(1)(B) and Violation of MHPAEA Under 29 U.S.C. §1132(a)(3). 

The plaintiff is represented by the Law Firm of Brian S King.