DMHC ORDERS UNITED HEALTHCARE TO PAY BENEFITS TO ANOREXIA PATIENT
Shepard v. United HealthCare
Kimberly Shepard, a young wife and mother, was in danger of losing her life from the debilitating effects of Anorexia Nervosa because her health insurer United HealthCare Insurance Company declined her claim for benefits to pay for residential treatment. Kantor & Kantor appealed to the California Department of Managed Health Care requesting that the DMHC immediately submit Shepard's case to an independent doctor for an examination and review after the U.S. District Court for the Eastern District of California denied Shepard's temporary restraining order to enjoin United HealthCare from continuing to withhold benefits.
Shepard sought treatment at Monte Nido residential treatment center in Calabasas, California, a preferred provider under Shepard's health policy. Although Shepard's condition more than met the policy's conditions for residential treatment, United HealthCare denied her claim. As a result, Shepard exhausted her family's financial resources to pay for treatment.
Within a month, the DMCH ruled that inpatient services at a residential treatment facility were medically necessary and ordered United Healthcare to resume payment for such care.