ERISA Alert

Since the majority of U.S. workers are covered by self-insured health plans offered through their employers, plan participants are especially vulnerable to denials of treatment. Self-insured policies offered through private employers are generally governed exclusively by ERISA, a restrictive federal law that incentivizes plan administrators to deny claims and leaves little latitude for independent judges to overturn medical necessity determinations.

Psych-Appeal urges thorough and informed advocacy of mental health treatment claims submitted for internal reviews in ERISA cases. Failure to raise all pertinent issues during the internal appeals process can preclude any subsequent chance of recovery in court.