Families sue insurers for refusing to cover wilderness therapy: 6 things to know

Several families have filed lawsuits against commercial payers for refusing to pay for their children's wilderness therapy, a treatment similar to residential mental healthcare except programs are administered outdoors, according to The Boston Globe.

Here are six things to know.

1. Most families admit their adolescent children to wilderness therapy as the last viable option to treat emotional and behavioral health ailments like depression, eating disorders and suicidal actions or thoughts. Patrick Sheehan, a Boston attorney who filed several of the lawsuits, told The Boston Globe adolescents undergoing wilderness therapy "are on the brink" and it's "a life-or-death choice for them."

2. An increasing number of families are suing payers for their refusal to cover wilderness therapy. In May, a Massachusetts family sued Wellesley, Mass.-based Harvard Pilgrim Health Care for denying payment for their son's outdoor behavioral therapy program at Springville, Utah-based RedCliff Ascent. His treatment for oppositional defiant disorder, substance use disorder, depression and low self-esteem cost his family $16,005, according to the report.

3. Another family in Massachusetts sued Boston-based Blue Cross Blue Shield of Massachusetts last fall for not covering wilderness therapy their daughter received an Evoke Therapy Program in Santa Clara, Utah. Similar lawsuits have been filed in Florida, Kentucky, New York and Utah, the report states.

4. The lawsuits have been strengthened by expanded federal regulations for mental healthcare coverage, according to the report. The wilderness therapy industry, albeit once marred by criticism after 10 deaths occurred at outdoor treatment sites between 1990 and 2004, has seen improvements. The Outdoor Behavioral Healthcare Council grants accreditation to programs to enhance standards, and states like Utah and Oregon license them.

5. Payers have argued the treatment is experimental and lacks medically-proven benefit, the report states. BCBS of Massachusetts and Harvard Pilgrim did not respond to The Boston Globe's inquiry as to why the payer denied coverage for wilderness coverage. 

6. Wilderness therapy supporters successfully lobbied for the establishment of billing codes for wilderness therapy treatment. The code will take effect July 1. While it will streamline the billing process for wilderness therapy, it will not require insurers to cover the services, the report states. 

More articles on payer issues:
UnitedHealthcare, University of Chicago Medicine solve contract dispute
Cleveland Clinic, Oscar Health to offer co-branded health plan
Centene to enter ACA exchanges in 3 states

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