The complaint, filed Oct. 31 in the United States District Court for the District of Massachusetts, accused BCBSMA of violating the terms of its insurance policies and self-funded medical benefit plans by denying claims for inpatient intermediate mental health residential treatment.
BCBSMA covers intermediate inpatient treatment for mental health and substance use disorders, which may include acute residential treatment, according to the lawsuit. However, the plaintiffs argue BCBSMA’s “restrictive interpretation” of what an intermediate treatment is leads to the exclusion of sub-acute residential treatment that is medically necessary.
The plaintiffs argue this reading violates contract terms as well as federal mental health parity laws and the Employee Retirement Income Security Act. The lawsuit projects 100 BCBSMA members have had residential treatment claims improperly denied and that thousands others could face similar denials in the future.
Becker’s requested comment from BCBSMA on the allegations. This article will be updated if more information becomes available.
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