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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:

HARLICK v. BLUE SHIELD OF CALIFORNIA

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Kantor & Kantor, LLP 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.

UPDATE:

On July 12, 2012, the 9th U.S. Circuit Court of Appeals issued its final and binding decision in Lisa Kantor's most influential case to date. In Harlick v. Blue Shield, 686 F.3d 699 (2012), the court denied Blue Shield's second request for rehearing of a significant decision in favor of people suffering from nine enumerated mental health conditions – Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, Major Depression, Obsessive-Compulsive Disorder, Panic Disorder, Eating Disorders (Anorexia Nervosa and Bulimia Nervosa), Autism or Pervasive Developmental Disorder, and Serious Emotional Disturbance in children and adolescents.

The court confirmed that California's Mental Health Parity Act requires health plans to provide coverage of "all medically necessary treatment" for "severe mental illnesses" under "the same financial terms as those applied to physical illnesses," and are obligated to pay for residential treatment for people with eating disorders even if the policy excludes residential treatment.

Harlick has been called a landmark decision and a turning point in the battle for insurance benefits to pay for residential treatment for people suffering from mental health conditions. Although the decision was issued in the context of anorexia, a district court cited Harlick in January 2012 to rule in favor of benefits for residential treatment for another Kantor client suffering from major depression and panic disorder. Burton v. Blue Shield, 2012 U.S. Dist. LEXIS 13487. Advocates believe Harlick will affect similar lawsuits and pending legislation around the country.

Kantor represented Jeanene Harlick, who has suffered from anorexia for more than 20 years. In 2006, her physicians recommended treatment at a facility qualified to treat eating disorders. Although Blue Shield agreed to pay for the treatment, after 10 days it denied coverage, saying the plan did not cover residential treatment even though the insurer agreed the treatment was medically necessary.

In July 2008, Kantor sued Blue Shield on Harlick's behalf, arguing, among other things, that Blue Shield's health plan violated the California Mental Health Parity Act. Blue Shield argued that it properly denied coverage under the terms of the plan, and the district court agreed. Harlick appealed, and the 9th Circuit ruled in her favor in August 2011.

Blue Shield requested a rehearing and a rehearing en banc. On June 4, 2012, the Court denied the request, withdrew its prior opinion of August 26, 2011, and issued a majority opinion by Judge William A. Fletcher with a dissenting opinion by Judge N.R. Smith. Blue Shield immediately filed another request for rehearing and rehearing en banc, which was denied in July 2012.

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