Cigna Is First Insurer to Beat Wilderness Therapy Challenge

Employee Benefits News examines legal developments that impact the employee benefits and executive compensation employers provide, including federal and state legislation, rules from federal...

By Jacklyn Wille

Cigna Corp. defeated a lawsuit challenging its failure to pay for wilderness therapy treatments, a move that critics say violates mental health parity law ( Welp v. Cigna Health & Life Ins. Co. , S.D. Fla., No. 9:17-cv-80237, 7/20/17 ).

The Mental Health Parity and Addiction Equity Act—which generally requires insurers to cover mental health treatments on the same terms that they cover medical and surgical care—doesn’t obligate Cigna to pay for a 22-year-old man’s treatment at Second Nature Therapeutic Wilderness Program in Utah, a federal judge ruled. The man’s father brought a proposed class action accusing Cigna of violating the parity act with its blanket exclusion for mental health services rendered in a wilderness therapy program. The judge dismissed the lawsuit July 20, calling it a mischaracterization of how Cigna evaluates benefit claims.

The ruling is good news for the other insurers that have been hit with proposed class actions over wilderness therapy programs in the past year. Similar cases are pending against Harvard Pilgrim Health Care Insurance Co., Oxford Health Insurance, Empire HealthChoice Assurance, UnitedHealthcare, Blue Cross Blue Shield of Minnesota, and Blue Cross Blue Shield of Massachusetts. Anthem Health Plans of Kentucky reached a confidential settlement in a similar lawsuit in December, and several other insurers are facing individual lawsuits involving wilderness therapy coverage decisions.

Wilderness therapy programs seek to treat young people with behavioral or substance abuse issues by combining traditional therapy methods with outdoor activities such as hiking and camping. Many come with a price tag of more than $500 per day for programs lasting weeks or months.

Here, the case against Cigna failed to state a violation of the mental health parity act because it was premised on an individual denial of coverage and not on a coverage limitation that applied more strictly to mental health benefits, the judge said.

The lawsuit is “virtually devoid of any comparisons between the limitations imposed on mental health/substance treatments and those on medical/surgical analogues,” the judge said. “Instead, it rests on the fact that coverage for a mental health treatment was sought and denied.”

Under this theory, any denial of mental health coverage would be a violation of the parity act, which isn’t how the statute operates, the judge said.

The judge gave the father until July 31 to file a new complaint, although he said that doing so “may be futile.”

Judge Donald M. Middlebrooks of the U.S. District Court for the Southern District of Florida wrote the decision.

Jordan Lewis PA and Whatley Kallas LLP represented the father. Carlton Fields Jorden Burt PA represented Cigna.

To contact the reporter on this story: Jacklyn Wille in Washington at jwille@bna.com

To contact the editor responsible for this story: Jo-el J. Meyer at jmeyer@bna.com

Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.

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