Employee Benefits News examines legal developments that impact the employee benefits and executive compensation employers provide, including federal and state legislation, rules from federal...
Harvard Pilgrim Health Care Insurance Co. must defend claims that it violated federal benefits law by allegedly failing to cover thousands of dollars in wilderness therapy programs for troubled teens.
The allegation that Harvard Pilgrim’s exclusion to cover services when delivered in the setting of a wilderness program violates the federal mental health parity law is sufficient to survive dismissal, Judge Denise Casper of the U.S. District Court for the District of Massachusetts held July 20.
Wilderness therapy seeks to treat young people with behavioral or substance abuse issues by combining traditional therapy methods with outdoor activities such as hiking and camping—often at a cost of more than $500 per day for programs lasting weeks or months.
In the past few years, nearly a dozen proposed class actions have challenged health plans’ alleged failure to cover this treatment. Cases have targeted companies and insurers, including Aetna Life Insurance Co., Anthem Blue Cross Blue Shield, United Healthcare, Regence BlueShield, Harvard Pilgrim, and Empire HealthChoice Assurance. So far, Cigna is the only insurer that has defeated one of these lawsuits. Earlier this year, a federal judge refused to dismiss similar claims against Microsoft Corp.
Casper rejected Harvard Pilgrim’s argument that the participants failed to allege a parity act claim because the plan’s exclusion for wilderness programs is a categorical one that applies to both medical and mental health conditions.
Casper, however, partially ruled in favor of the insurer by tossing an Affordable Care Act claim against it. The participants can move forward with their claim that the wilderness program exclusion violates the ACA because the statute doesn’t provide a private right of action to sue, Casper said.
Whatley Kallas LLP and Jordan Lewis P.A. represent the families. Donoghue Barrett & Singal PC represents Harvard Pilgrim.
The case is Vorpahl v. Harvard Pilgrim Health Ins. Co., 2018 BL 258398, D. Mass., No. 17-cv-10844-DJC, order denying in part defendant’s motion to dismiss 7/20/18.
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