A Texas appellate court handed Blue Cross and Blue Shield of Texas a win against a lawsuit targeting the insurer's mental health coverage.
The initial suit accused the insurer of improperly denying coverage to the plaintiff's teenage daughter, who had been hospitalized for anxiety, depression and suicide attempts, and Blue Cross and Blue Shield of Texas only reimbursed the plaintiff for part of the treatment, according to the ruling.
Blue Cross and Blue Shield of Texas served as the claims administrator for the plaintiff's employer-funded health plan, which gave them the ultimate decision to approve or deny claims.
The court sided with the insurer, which used Milliman Care Guidelines to determine when care was no longer medically necessary. The court ruled the payer did not abuse discretion and was proper with its denial of benefits, according to the ruling.