Home > Uncategorized > New Case: California Mental Health Parity Act Requires Health Plan to Provide Coverage of All Medically Necessary Treatment for Enumerated Severe Mental Illness Under Same Terms Offered for Physical Illness

New Case: California Mental Health Parity Act Requires Health Plan to Provide Coverage of All Medically Necessary Treatment for Enumerated Severe Mental Illness Under Same Terms Offered for Physical Illness

August 11, 2012

Harlick v. Blue Shield of California (United States Court of Appeals, Ninth Circuit, June 4, 2012, Case No. 10-15595)

Brief summary.  The California Mental Health Parity Act and related regulations require that plans within the scope of the Act must provide coverage of all medically necessary treatment for enumerated severe mental illnesses under the same financial terms as those applied to physical illnesses.  Harlick was an anorexia sufferer.  For mental illnesses, Harlick’s plan covered inpatient services including hospitalization and psychiatric day treatment, limited outpatient services, office visits, psychological testing, and in-person or telephone counseling sessions.  Residential care for treatment of mental illness was not covered, and the plan did not define the term “residential care.”  For physical illnesses, the plan covered hospital treatment, outpatient treatments, office visits, and forms of “subacute care” including skilled nursing or skilled rehabilitation care.  In accord with her doctors’ orders, Harlick registered at a residential care facility that specialized in eating disorders.  Blue Shield paid for eleven days of Harlick’s treatment but refused to pay for the remainder. Blue Shield ultimately denied coverage for the majority of Harlick’s claim at the residential care facility as non-covered residential care.  Harlick brought suit.  The District Court granted Blue shield’s motion for summary judgment and denied Harlick’s motion for summary judgment.  The Ninth Circuit reversed holding that the Parity Act requires a health insurer to pay for an insured’s mental illness, in this case residential care which was otherwise not covered under the terms of the plan, on the same financial terms and conditions that the plan provides for coverage for physical illness.  Of course, you need to read and evaluate the entire holding for your particular situation.

Dave Tate, Esq. (San Francisco)

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