The claimant was diagnosed with anorexia nervosa and required residential mental health treatment after outpatient and partial hospitalization care proved inadequate. Blue Shield denied coverage while continuing to cover analogous inpatient medical services. Blue Shield relied on plan exclusions to deny residential mental health treatment despite medical necessity and despite parity protections under California law. […]

The claimant sought coverage for residential mental health treatment after being diagnosed with anorexia nervosa. Her treating physicians determined that outpatient and partial hospitalization care had failed and that residential treatment was medically necessary to address the severity of her condition. Blue Shield denied coverage and issued a denial letter that relied on specific policy […]