Parity Prevails After Cigna Wrongfully Denies Mental Health Treatment Claims

Posted By Kantorlaw || 15-Jan-2014

Kantor & Kantor, LLP celebrates a fantastic victory announced today by New York Attorney General Eric T. Schneiderman. After exposing Cigna Corporation for numerous wrongful mental health insurance denials, Attorney General Schneiderman's office reached a settlement agreement. The settlement requires Cigna to reprocess and pay hundreds of claims for nutritional counseling for mental health conditions, including eating disorders, to members who were wrongfully denied access to those benefits.

In 2010, New York Attorney General Schneiderman received complaint from a family whose daughter suffered from anorexia nervosa. The complaint detailed that Cigna had denied their daughter access to insurance benefits for nutritional counseling, a necessary component of treatment for patients suffering anorexia. As a result of Cigna's denials, the family paid $2,400 out of pocket for their daughter's nutritional counseling. After digging deeper on the matter, Schneiderman launched an investigation into how Cigna administers their mental health benefits. The investigation revealed that Cigna had wrongfully denial of hundreds of claims for nutritional counseling for mental health conditions.

Although frequently evaded and violated by insurance companies, federal mental health parity is designed to protect those with mental illness, and must be followed. NY state's parity law mandates that health insurance companies must provide mental health benefits on par with other medical benefits. Cigna unmistakably violated this law because they limited the number of nutritional counseling session to only three visits for patients with mental health conditions while placing no limits on nutritional counseling visits for those with medical or physical diseases. For instance, Cigna capped nutritional counseling to only three visits to those suffering with eating disorders, while allowing those with physical illnesses (such as diabetes) to receive nutritional counseling without limits.

Working with a complete treatment team (including a registered dietician specializing in eating disorders) is imperative to successful eating disorder recovery. According to the American Psychiatric Association's Practice Guideline for the Treatment of Patients with Eating Disorders, nutritional counseling is "a useful part of treatment and helps reduce food restriction, increase the variety of foods eaten, and promote healthy but not compulsive exercise patterns, and is an empirically supported strategy for the treatment of binge eating."

"Unfortunately, many of our clients have received similar insurance denials for the treatment of their eating disorder," said Lisa Kantor, founding partner of Kantor & Kantor, LLP, LLP. "I understand that eating disorders are life-threatening brain based mental illnesses, I understand that eating disorders have the highest mortality rate of all mental illnesses, and I also understand that evidence-based medical guidelines support the valuable role of nutritional counseling in the treatment of eating disorders. Regrettably, insurance companies do not always understand this critical need for appropriate and effective eating disorder treatment."

This settlement is of great significance, as it shines the spotlight on the continued and frequent mental health parity violations that the insurance industry would rather keep hidden in the shadows. This settlement places pressure on insurers to comply with the rules of mental health parity laws, or face serious consequences. And we can only hope that this settlement will finally cause insurance companies realize what those of us who work in the field, or know someone with an eating disorder, have known for a long time now: paying for proper and adequate treatment is not only cost-effective, but it saves lives too.

If you have experienced a mental health parity violation, or an insurance denial for the treatment of your eating disorder, please do not hesitate to contact our office for help. We spend every working day battling insurance companies for the health benefits to which our clients are entitled, so that they can receive the treatment they need to continue on the path to recovery.

Visit us on the web at www.kantorlaw.net or call us for a no-cost consultation at (800) 446-7529.

We understand, and we can help.

For more on Attorney General Eric T. Schneiderman's announcement, see http://www.ag.ny.gov/press-release/ag-schneiderman-announces-settlement-health-care-insurer-wrongfully-denying-mental.

Contact Us

Email Us Your Information

Please specify the subject(s) of your claim:
Has the insurance company already denied your claim?
What is the name of your insurance company?
Briefly describe the nature of your claim:
Please note: confidential or time-sensitive information should not be sent through this form, as we may not be able to act or reply before your deadlines. Please call us directly instead. Further, the use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship.
I have read and understand the disclaimer above.
Send Your Information