Harvard Pilgrim Sued Over Wilderness Therapy Coverage

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By Jacklyn Wille

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 jwille@bna.com

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

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