Comcast Corporation and Magellan Health Services, Inc. face a proposed class action over their alleged refusal to include in their health insurance plan coverage for mental health services rendered at wilderness therapy programs.
The plaintiff, a pseudonymous health plan participant whose daughter’s wilderness therapy was not covered under the plan, alleges the defendants deny coverage of such treatment despite covering “comparable” medical services rendered at skilled nursing facilities and rehabilitation hospitals. The lawsuit argues that under the Mental Health Parity and Addiction Equity Act, mental health treatments covered under a health insurance plan must not be more restrictive than covered medical/surgical services.
“But that’s exactly what happened here,” the complaint avers. While the plaintiff’s coverage request for medically necessary mental health services was denied “on the strength of a plan exclusion for such services,” the defendants provided coverage for medical services rendered at skilled nursing facilities and rehabilitation hospitals, which are considered “comparable” to wilderness therapy programs under the Parity Act.
According to the case, the plaintiff worked for NBC, now owned by Comcast, between 1985 and 2017, after which she obtained health coverage through a COBRA plan administered by Comcast. Magellan, the suit says, was retained to process claims and appeals for “Behavioral Health” services.
Per the complaint, the plaintiff’s daughter was diagnosed by the time she was 14 with several disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders for which she received medically necessary treatment at a wilderness therapy program between July and September 2017. The plaintiff was charged $29,205 for the program, after which she submitted a coverage claim to Comcast, the case says.
In a response on Magellan letterhead, the defendants indicated without explanation that insurance coverage was not provided, according to the suit. When the plaintiff appealed the decision, she received a response affirming the previous denial on the basis that “[t]he plan does not provide coverage for wilderness programs,” the lawsuit relays.
The plaintiff looks to represent the following proposed classes:
“All persons (a) insured by a certificate of coverage (b) underwritten by Comcast Corporation (c) whose wilderness therapy coverage requests were denied (d) because the applicable health insurance plan specifically excluded wilderness therapy from coverage.”
“All persons (a) whose self-funded ERISA-regulated health insurance plans were (b) administered by Magellan and (c) whose wilderness therapy coverage requests were denied (d) because the applicable health insurance plan specifically excluded wilderness therapy from coverage.”
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