Two plaintiffs are accusing Blue Shield of California of improperly denying mental health and drug treatment claims for their children's care, according to a California Healthline report.
The allegations come via a class-action lawsuit initially filed in the U.S. District Court for the Northern District of California.
In the lawsuit, the plaintiffs claim Blue Shield and the insurer's mental health claims administrator, Magellan Health Services of California, denied their children coverage under the plaintiffs' employer-based plans for outpatient and residential mental health treatment, according to the report.
Blue Shield and Magellan "are violating legal and fiduciary duties they owe to health insurance plan participants and beneficiaries by improperly restricting the scope of their insurance coverage for residential and intensive outpatient mental health and substance abuse treatment," the lawsuit states. "These restrictions are inconsistent with the terms of the relevant insurance plans and generally accepted professional standards in the mental health and substance abuse disorder treatment community. They were also adopted and applied by defendants in breach of defendants' fiduciary duties."
The plaintiffs, Charles Des Roches and Sylvia Meyer, specifically accuse Blue Shield and Magellan of violating the Employee Retirement Income Security Act and creating criteria "that violate accepted professional standards and the terms of the health plan itself," reports California Healthline.
In an email to California Healthline, Blue Shield said they "disagree with the allegations in the lawsuit" and would continue to "defend the case vigorously." Magellan declined to comment to the publication, although it has denied the allegations in court documents, according to the report.
The plaintiffs call for Blue Shield and Magellan to "change [their] policies and practices so as to comply with its fiduciary obligations and to make benefit determinations which are consistent with plaintiffs' plans, generally accepted professional standards in the mental health and substance abuse disorder treatment community, and applicable law." The plaintiffs also call for the reprocessing of thousands of mental health and substance-use benefit denials, according to the report.