California Court of Appeal issues important decision requiring insurers to provide all medically necessary mental health treatment for insureds with Severe Mental Illnesses
LOS ANGELES, June 13, 2014 /PRNewswire/ — On Tuesday, June 10, 2014 the California Court of Appeal issued its decision in Marissa Rea v. Blue Shield of California. The Court held that the California Mental Health Parity Act requires Blue Shield to provide all medically necessary treatment for people suffering from severe mental illnesses, including anorexia and bulimia.
The case involved Blue Shield’s denial of residential treatment for the plaintiffs’ eating disorders. Blue Shield based its denial on an exclusion for residential treatment in its policies. Blue Shield argued that all the Parity Act required was “equality” of treatment between mental and physical illnesses and, since its policy did not cover residential treatment for physical illnesses, it did not have to provide residential treatment for severe mental illnesses.
The Court of Appeal rejected Blue Shield’s argument, holding:
[T]he language and background of the Parity Act establish that residential treatment for eating disorders must be covered by health care service plans such as Blue Shield’s plan. We do not interpret the concept of “parity” to require treatments for mental illnesses to be identical to those mandated for physical illnesses; rather, given the principle that treatments for the two types of illnesses are in many cases not comparable, parity instead requires treatment of mental illnesses sufficient to reach the same quality of care afforded physical illnesses.
The Rea decision is an important affirmation of the broad scope of mental health coverage required under California’s Mental Health Parity Act for the treatment of those with anorexia, bulimia and other severe mental illnesses. Lisa Kantor, who argued the case to the Court of Appeal, is pleased that the California Court is now in line with the Ninth Circuit’s position on this matter. “This decision confirms that residential treatment is one of the most effective treatments for eating disorders, and must be available to all California insureds who need this treatment,” said Kantor. The plaintiffs in Rea were represented by Lisa S. Kantor and J. David Oswalt of Kantor & Kantor, LLP in Los Angeles, California.
About Kantor & Kantor, LLP
Kantor & Kantor is the largest law firm in the country exclusively representing plaintiffs who have been denied insurance benefits from life, health, disability, and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters, and files more ERISA cases than any other law firm in California. For more information, log on to www.kantorlaw.net, call (800) 446-7529, or follow the firm at http://www.kantorlaw.net/Eating_Disorder_Blog.aspx.
SOURCE Kantor & Kantor, LLP