Magellan/Blue Shield of California Mental Health Guidelines Class Action Certified
A class has been certified in a lawsuit alleging that proprietary internal guidelines used by Blue Shield of California and Human Affairs International of California, a subsidiary of Magellan Health, improperly restrict insurance coverage for mental health and substance use treatment.
According to the complaint in Charles Des Roches, et al. v. California Physicians’ Service, et al., the guidelines used by Magellan and Blue Shield systematically restrict coverage for claimants seeking these levels of care “unless such claimants can meet a set of requirements entirely different from, and often conflicting with, the generally accepted professional standards for treatment.” The complaint alleges that the companies’ criteria directly violates the terms of the health plans administered by Magellan and Blue Shield, and the legal and fiduciary responsibilities they owe to plan participants and beneficiaries.
The plaintiffs allege the insurers repeatedly denied mental health and substance abuse claims for their teenage children despite the plaintiffs having coverage through employer-based plans.
The decision of the U.S. District Court for the Northern District of California certified the action to proceed as a class action on behalf of participants and beneficiaries who sought and were denied coverage for residential and intensive outpatient treatment for mental health and substance use disorders from January 1, 2012, to the present.
In an interview with California Healthline, Meiram Bendat, founder of Psych-Appeal, said that if the case succeeds, “it is hard to imagine that Magellan would be able to justify continued use of its proprietary guidelines in other markets.”
The plaintiffs in this case are represented by Psych-Appeal, in conjunction with Zuckerman Spaeder LLP and Grant & Eisenhofer P.A.
Previous news:
Magellan/Blue Shield of California Lawsuit Alleges Improper Denial of Care to Teens
Related coverage:
Blue Shield Improperly Denied Mental Health, Drug Treatment Claims, Suit Alleges, California Healthline, July 11, 2017