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. is the latest insurer to be sued for allegedly failing to cover wilderness therapy programs for troubled teens ( Vorpahl v. Harvard Pilgrim Health Care Ins. Co. , D. Mass., No. 1:17-cv-10844-DJC, complaint filed 5/12/17 ).
The proposed class action, filed May 12 in a Massachusetts federal court, argues that Harvard Pilgrim’s failure to cover wilderness therapy programs violates the federal mental health parity law, which generally requires insurers to cover mental health treatments on the same terms that they cover medical and surgical care. As a result of this violation, a Harvard Pilgrim plan participant was forced to pay more than $16,000 out of pocket for her teenage son’s monthlong stay at Red Cliff Ascent in Utah, the lawsuit alleges.
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 weekslong or monthslong treks. This is the sixth proposed class action involving wilderness therapy to be filed in the past year. Lawsuits are pending against Cigna Corp., Oxford Health Insurance, Empire HealthChoice Assurance and Blue Cross Blue Shield of Massachusetts. Anthem Health Plans of Kentucky privately settled a similar lawsuit in December.
Like the lawsuits against Cigna and Blue Cross, the case against Harvard Pilgrim challenges an alleged blanket exclusion in the insurer’s health plan for wilderness therapy. By contrast, Oxford is accused of denying coverage for wilderness therapy under a plan provision excluding treatments that aren’t “evidence-based.”
A spokeswoman for Harvard Pilgrim declined to comment on the lawsuit, citing a general rule against discussing litigation matters.
Jordan Lewis PA and Whatley Kallas LLP represent the health plan participant who filed suit against Harvard Pilgrim. Jordan Lewis has filed each of the five other proposed class actions seeking coverage for wilderness therapy, and Whatley Kallas is involved in the lawsuits against Cigna, Oxford and Blue Cross.
To contact the reporter on this story: Jacklyn Wille in Washington at email@example.com
To contact the editor responsible for this story: Jo-el J. Meyer at firstname.lastname@example.org
Text of the complaint is at http://www.bloomberglaw.com/public/document/Vorpahl_v_Harvard_Pilgrim_Health_Care_Insurance_Company_Docket_No/1.
Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)