Health Benefits Archives

When to Hire a Health Insurance Claim Denial Lawyer

by Matthew Maloney | Apr 22, 2021 | Health Benefits

Navigating a denial of your private health insurance claim at a time when your focus is on receiving the medical care you need can seem like an uphill battle with your insurance company. Healthcare claims are often complex. It is important to consult with a lawyer who focuses on health insurance claims and possesses the expertise and knowledge to get your claim approved and prevent you from being stuck with a medical bill that your health insurer should pay. […]

How Denial of Autism Care Coverage Can Breach ERISA Duty

by Mark Debofsky | Apr 8, 2021 | ERISA, Fiduciary Duties, Health Benefits, Mental Health Parity

According to statistics compiled by the Centers for Disease Control and Prevention, about one in 54 children has been diagnosed with autism spectrum disorder, which is considered a developmental disability associated with social, communication and behavioral issues. Although there is no known cure for autism, children with autism may be helped with behavioral treatment such as applied behavioral analysis, or ABA, and early intensive behavioral intervention, or IBT, a subtype of ABA treatment. […]

UnitedHealth ERISA Ruling Exposes Faults in Health Coverage

by Mark Debofsky | Nov 25, 2020 | Disability Benefits, ERISA, Health Benefits

The availability of health insurance coverage for treatment of mental health conditions recently took a huge step forward with the entry of judgment by the U.S. District Court for the Northern District of California in Wit v. United Behavioral Health.[1] After the issuance of a ruling in 2019 finding United Behavioral Health, or UBH — a UnitedHealth Group […]

8th Circuit Denies Undocumented Worker’s Employer Health Benefits

by Mark Debofsky | Sep 17, 2020 | ERISA, Health Benefits

Are undocumented employees entitled to the same employer-sponsored benefits as their co-workers? According to a recent ruling from the 8th U.S. Circuit Court of Appeals, apparently not. In Avera McKennan v. Meadowvale Dairy Employee Benefit Plan, 2020 WL 5085954 (8th Cir., Aug. 28), the appeals court ruled that a hospital (Avera) was unable to recoup significant […]

Health Benefit Ruling Raises Reviewer Neutrality Questions

by Mark Debofsky | Aug 17, 2020 | Disability Benefits, Health Benefits

The Patient Protection and Affordable Care Act[1] made a number of significant changes to health insurance coverage in the U.S. One of the most important provisions of the law, which is also known as Obamacare, was a requirement that patients whose benefits are denied are entitled to independent external review. The implementing regulation[2] requires that […]

Court Rejects Finding on Claimant’s Mental Health Insurance Benefits

by Mark Debofsky | Aug 7, 2020 | Health Benefits

There has been a growing number of rulings relating to health insurance denials involving mental health treatment. A recent example is Jamie F v. Unitedhealthcare Insur. Co., 2020 WL 4249200 (N.D. Cal., July 23), involved a claimant who had a long history of being treated for several mental illnesses including anorexia nervosa, depression, anxiety, obsessive-compulsive disorder and self-harming behaviors.

Health Benefits