On Wednesday a case was filed in the Eastern District of California against the Wine Group Inc. Health Benefit Plan. The case is regarding recovery of ERISA benefits for inpatient rehab treatment.
The patient, per their complaint, was treated for alcohol addiction on an in-patient basis at Duffy’ s Napa Valley Rehab in Napa Valley, California. The facility, while inpatient, was not a hospital-level rehab and in order to qualify for the lower level of care, the patient had to be treated with detox medications for a week prior to joining the treatment program.
However, the medical group and its third party administrator denied the claim as not medically necessary and refused payment for the services, court documents say. The plaintiff argues that four subsequent visits to other facilities were approved and paid for by the group and it is only the Duffy’s treatment that was rejected as not medically necessary, which the plaintiff argues was improper.
The plaintiff is suing for recovery of benefits, declaratory judgment as to the necessity of the payment, and attorneys fees. The plaintiff is represented by the Law Office of Robert F. Keehn.