Blue Shield Must Provide Residential Care Benefits for Substance Abuse: Mental Health Parity Mandates Coverage for Underlying Depression and Panic Disorders

Posted By Kantorlaw || 2-Feb-2012

LOS ANGELES, JANUARY 18, 2012 – Kantor & Kantor, LLP, LLP announced today that the U.S. District Court for the Central District of California ruled in favor of the firm’s client Laura Burton, deciding that California’s Mental Health Parity Act mandates that Blue Shield of California must provide benefits for residential treatment of Ms. Burton’s major depressive disorder and panic disorder.

“Mental health parity is firmly established law in California,” said Lisa Kantor, who represents Ms. Burton. “Blue Shield continues to act as if the Act doesn’t exist by denying residential treatment when it is clearly medically necessary. That attitude is offensive to both policyholders and the legal system.”

In Burton v. Blue Shield of California, the court held that under the Act, Blue Shield must cover “medically necessary treatment of severe mental illnesses” under “the same terms and conditions applied to other medical conditions. … The Ninth Circuit interpreted the Act to require that insurance companies provide coverage under the same financial terms and conditions for medically necessary treatment of ‘severe mental illnesses’ and medical conditions.”

The Ninth Circuit case the district court referred to is Harlick v. Blue Shield of California, an August 2011 ruling that determined California’s Mental Health Parity Act requires insurers to pay for eating disorder treatment at residential facilities. That case, in which Ms. Kantor represented a plaintiff denied residential treatment benefits for anorexia, was the first decision to determine that the phrase “same terms and conditions” included financial terms. The court cited in that ruling the nine mental illnesses enumerated in the Act: Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, Major Depression, Obsessive-Compulsive Disorder, Panic Disorder, Eating Disorder (Anorexia Nervosa and Bulimia Nervosa), Autism or Pervasive Developmental Disorder, and Serious Emotional Disturbance in children and adolescents.

The Burton court, dealing with major depression and panic disorders, relied on that language, pointing out the impossibility of separating treatment for severe underlying mental illnesses from treatment for alcohol dependency.

For more information about Lisa Kantor and legal assistance for residential treatment for mental illness, log on to http://www.kantorlaw.net/Areas_of_Practice/Eating_Disorders.aspx, or follow Ms. Kantor at http://www.facebook.com/pages/Eating-Disorder-Legal-Assistance/163785873661013.

About Kantor & Kantor, LLP, LLP

Kantor & Kantor, LLP is the largest law firm in the country exclusively representing plaintiffs who have been denied insurance benefits from life, health disability and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters. For more information, log on to Kantor & Kantor, LLP, call (800) 446-7529, or follow Kantor & Kantor, LLP at www.californiainsurancelawyerblog.com.

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