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A primer on behavioral health residential treatment cases

Our firm recently won the case of Dominic W v. Northern Trust Co. Employee Welfare Benefit Plan, 2019 WL 2576558 (N.D. Ill. June 24, 2019), which took a health benefit plan to task for denying residential treatment behavioral health claim. The case involved coverage for Sofia W, the daughter of a Northern Trust employee, who […]

Insurers send payments directly to patients depriving providers of reimbursement for services

A recent CNN report (“Insurer skips doctors and sends massive checks to patients, prompting million-dollar lawsuit” March 1, 2019) highlights a serious problem faced by medical providers such as mental health rehabilitation facilities in obtaining payment for the services they provide. Health insurers typically allow patients to assign payment for the services they receive in order […]

Mental health insurer guideline ruling may become national template

Over the past several years, many health insurers have adopted coverage and level of care guidelines in an effort to provide consistency in determining insurance coverage for mental health treatment. A recent ruling in a class action in California addressed whether the guidelines utilized by a major health insurer met generally accepted standards of care. […]

Federal judge finds insurance giant UnitedHealth violated ERISA law

Approximately 50 percent of Americans receive health insurance through their employer, making most of those plans subject to the Employee Retirement Income Security Act of 1974 (“ERISA”). After passage of the Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”), the majority of health plans that cover mental health treatment, including large employer- sponsored […]