Insurance Company Sued Over Denial Of Mental Health Coverage

Insurance giant Aetna, along with and Ashbury Automotive Group, Inc. are under suit from two plaintiffs that say they violated both the Employment Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act (MHPAEA) after repeatedly denying their claims. . The suit, filed last Friday in the District of Utah, was brought when Aetna repeatedly denied the submitted insurance claims of the plaintiffs.

According to the complaint, K.G. was a participant in an Aetna plan while E.G., K.G.’s daughter, was a beneficiary. E.G. grew up with learning differences, anxiety, depression, anger, and a generalized mood disorder, the filing said.

When she developed suicidal ideation, the complaint explained, her parents placed her in inpatient care at a series of four adolescent care facilities, both in the United States and in Costa Rica. One facility, Pure Life, was described in the complaint as a “therapeutic program for young adults struggling with mental health disorders.”

According to K.G., Aetna denied coverage on the basis that their policy that “mental health residential treatment programs must have a behavioral health provider actively on duty 24 hours per day for 7 days a week.” They elaborated that the programs must “be an institution specifically licensed as a residential treatment facility by applicable state and federal laws.”

The plaintiffs claimed that Aetna violated both ERISA and MHPAEA because the requirement was not mirrored in analogous medical or surgical care. They maintained that two of the treatment centers should be considered a behavioral health provider under the terms of the plan. Aetna responded to all of the plaintiff’s appeals with reasoning nearly identical to the first denial, the complaint said, appearing to not have considered any points brought up in the subsequent appeals.

K.G. and E.G. are represented by Brian S. King.