Case Study: Harlick v. Blue Shield
NOTICE: ON AUGUST 26, 2011, THE UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT RULED IN FAVOR OF JEANENE HARLICK AND HELD THAT CALIFORNIA'S MENTAL HEALTH PARITY ACT REQUIRED BLUE SHIELD TO PAY FOR HER CARE AT A RESIDENTIAL TREATMENT FACILITY. READ THE COURT'S DECISION BY CLICKING HERE:
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Kantor & Kantor is challenging denial of benefits on behalf of Jeanene Harlick in an appeal to the 9th U.S. Circuit Court of Appeals, which reviews cases that fall under the federal Employee Retirement Income Security Act, the law that governs employer-provided health plans.
Jeanene has suffered from anorexia for more than 20 years. Her physicians, backed by extensive research and professional recommendations, facilitated her admittance into residential treatment as perhaps the only option that could successfully treat her illness. After initially agreeing to coverage, Jeanene's health insurer Blue Shield of California refused to pay for the treatment because, they insisted, residential care is not covered in her policy. Whether or not this assertion is accurate is unclear because the policy is written is such a way that leaves the question of residential care coverage open. Indeed, Blue Shield changed its mind several times about what was or was not covered, and provided alternate and competing reasons for denial. And despite Jeanene's requests, Blue Shield never explained why the California Mental Health Parity Act did not require payment of her claim.
We have petitioned the 9th Circuit to review and overturn the lower court's decision that Blue Shield did not abuse its discretion when it denied Jeanene's benefits. We assert that Blue Shield's statement that residential care is not covered, is a violation of California's Mental Health Parity Act.
We hope to see health plans apply California's Mental Health Parity Act and provide benefits to individuals seeking residential treatment for eating disorders. It would reinforce state law that mandates mental illnesses be treated under the same terms and conditions as other medical conditions. And it could enable thousands of people suffering from eating disorders to finally receive the comprehensive, often life-saving treatment to conquer their disease.