r.b. v。联合行为健康
提起:2021年5月12日◆§1:21-CV-00553
诉讼索赔联合行为健康非法否认对心理健康和药物滥用治疗的覆盖范围被认为是“未经证实的”。
联合行为健康(United Behavioral Health)正面临一项拟议中的集体诉讼,据称该公司非法拒绝为某些“未经证实的、实验性的或调查性的”精神健康和药物滥用治疗提供保险。
更具体地说,14页诉讼涉及保险公司通过发布覆盖在住宅治疗中心提供的所有心理健康和药物滥用服务的毯子拒绝覆盖,特别是当该计划的任何组成部分时,否则被认为是未经证实的,实验或调查。
根据诉讼,联合行为健康不适用于熟练护理设施的“未经证实的,实验或调查”服务相同的覆盖范围。根据本案,熟练的护理设施和康复医院被认为是“可比较”对住宅治疗中心的差价法,禁止妨碍提供精神卫生治疗的卫生计划,这些卫生处理覆盖率限制了该计划的医疗和外科福利。
“这种不同的待遇在可比的服务中违反了联邦平等法案”。
该诉讼由一名伪匿名原告提出,其未成年子儿子受到由人类雇主普通电气公司赞助的联合行为健康保险计划的涵盖。本诉讼,原告的儿子在亚利桑那州许可的长期住宅待遇在10个月内获得精神健康和药物滥用治疗,原告被收取66,800美元。诉讼索赔被告否认原告对覆盖范围的索赔,因为该中心方案的一个方面,马治疗,“被认为是未经证实的”,因此未在该人的健康保险计划下涵盖。
The case contends that United Behavioral Health’s denial of the plaintiff’s entire claim because one aspect of his son’s treatment was considered by the claims administrator to be unproven, experimental or investigational violates the Parity Act given the defendant does not apply the same coverage exclusions to medical and surgical benefits. According to the lawsuit, when certain programming at skilled nursing and rehabilitation facilities is considered to be unproven, the defendant excludes those services from coverage but “does not take the position that inclusion of those services voids all coverage obligations for services incurred at skilled nursing facilities and rehabilitation hospitals – just the services found to be unproven.”
“这种覆盖方法并不是与被告人涵盖未经证实的,实验或调查编程在可比较的环境中的界别,”申诉辩称,索赔被告被被告排除的心理健康和药物滥用治疗的覆盖范围是“标准化实践”。
The lawsuit looks to represent anyone covered under an ERISA-governed healthcare plan administered or insured by United Behavioral Health whose requests for coverage for mental health and substance abuse treatment services rendered at a licensed residential treatment facility were denied in total based on the defendant’s determination that a component of the services is considered experimental, investigational or unproven.
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