Lawsuit Says Anthem Violated Calif. Mental Health Parity Act
Last week, an Anthem Blue Cross policyholder filed a class-action lawsuit alleging that the insurer has unlawfully denied coverage of recommended care to PPO members with eating disorders, KPCC's "KPCC News" reports.
Details of Lawsuit
The lawsuit -- filed Aug. 19 in Los Angeles Superior Court -- alleges that the insurer has violated the California Mental Health Parity Act of 1999 by refusing to cover such treatments.
Kathryn Trepinski -- a lawyer for the plaintiff -- said that under the act, "people with severe mental illness are entitled to the same care and treatment as people who have just physical illness" (O'Neill, "KPCC News," KPCC, 8/26).
All health plans within the scope of the act must cover medically necessary treatments for nine mental health conditions, including eating disorders (California Healthline, 9/6/11).
The plaintiff -- Shelby Oppel -- said that she sought treatment for bulimia nervosa, an eating disorder classified as a "severe" mental illness by the law.
The complaint alleges that Anthem:
- Uses guidelines for treating eating disorders that are based on outdated psychiatric protocols to save the company money;
- Illegally discriminates against those with eating disorders; and
- Interferes with the personal judgment of physicians.
The lawsuit seeks $4,000 for each PPO policyholder who since 2009 has sought full treatment for an eating disorder but was denied coverage by Anthem.
Darrel Ng -- a spokesperson for Anthem -- said, "We cannot comment on the complaint specifically, but Anthem's mental health protocols are lawful and appropriate."
He added, "[S]hould there be a dispute about the medical necessity of any treatment, every Anthem member is entitled to an independent medical review overseen by state regulators" ("KPCC News," KPCC, 8/26).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.