Health Plan Sued for Failing to Cover Mental Health Treatment, Despite Physical Complications

On Friday a case was filed in the District Court of Colorado by an ERISA health insurance plan beneficiary on behalf of their minor child against Sanford Health and the Sanford Employee Health Plan. The case was regarding improper denial of mental health treatment under the Mental Health Parity and Addiction Equity Act (MHPAEA).

Under the plan, the complaint detailed, the patient minor child could receive residential inpatient treatment so long as the provider was in-network and the patient met certain threshold symptoms. The patient could receive out-of-network treatment only in limited circumstances and for limited periods of time subject to a heightened set of standards.

According to the filing, the patient met the mental health requirements for treatment, but also had a physical health complication of type 1 diabetes, which the in-network facilities were unable to accommodate and which the beneficiary sought combined treatment for at an out-of-network facility. The health plan paid for initial treatment, but denied the remainder of the stay.

The plaintiff is suing for recovery of benefits and violation of the MHPAEA requirements for treatment at parity with medical benefits. The plaintiff is represented by McDermott Law.