Actually, a class action lawsuit is filed against Blue Shield of California, as well as Magellan Health Services (its claims administrator). The suit accuses the health plan provider of failing to provide patients’ with outpatient and mental treatment.
The plaintiffs who filed the lawsuit against Blue Shield of California are two parents. They state that the company didn’t provide their kids with the appropriate coverage under the employer-based health insurance plans.
The lawsuit claimed the plaintiffs’ children needed medical help. The reason is that they suffered from mental and substance abuse problem.
Psych-Appeal Inc., Grant & Eisenhofer PA, and Zuckerman Spaeder LLP are representing the plaintiffs.
It’s worth noting that it was in June when the suit received class-action status. Thus, this gives patients who appeared in the same situation the opportunity of joining the lawsuit as plaintiffs.
In fact, the complaint alleges Blue Shield of California and Magellan Health Services violated the following law: the Employee Retirement Income Security Act.
This is the federal law, which aims to regulate the benefit plans of employees. In addition to that, the suit asserts that the defendants violated the standards and terms of the health plan.
Furthermore, the plaintiffs mentioned in their complaints that the defendants provided residential patients with coverage under certain conditions.
That’s to say, the insurers offered the coverage, if the patients received less intensive treatment within the last months and it was not successful.
According to the suit, defendants’ approach doesn’t comply with the standards, set by professional groups. One of such professional groups is American Psychiatric Association.
What the lawsuit seeks
The lawsuit is seeking to alter the insurers’ policies and make them follow the professional standards concerning its health plans. Additionally, plaintiffs seek the following: the insurers’ should reprocess mental health, as well as substance-use benefit denials.
About Blue Shield of California
Blue Shield of California is a health plan provider and a member of the Blue Shield Association. It aims to provide patients with health care.
The foundation of the health plan provider goes back to 1939 by California Medical Association. It offers health care services to about four million health plan members. It was in 2014, when Blue Shield of California was stripped of its tax-exempt status.