Two minors were denied coverage under their fathers’ Aetna health benefit plans for mental health and substance use programs, the complaint for this class action says, because of the plans had improper exclusions for licensed wilderness therapy programs and licensed residential treatment centers. Both plans are covered under the Employee Retirement Income and Security Act (ERISA).
Two classes have been proposed for this action.
- The Aetna Wilderness PPO Class is all persons covered under an ERISA-governed self-insured health benefit plan (1) with similar mental health and substance abuse coverage grants and exclusions to the plan covering VG (2) that is administered by Aetna Life and (3) who required treatment at one or more licensed wilderness therapy programs during the class period.
- The Aetna RTC Fully-Insured Class is all persons covered under an ERISA-governed health benefit plan fully-insured by Aetna Life that covers mental or nervous disorders or substance abuse care and who required treatment at one or more licensed residential treatment centers during the applicable class period.
The class period extends back to June 14, 2013 or June 14, 2012, depending on the specific point of law cited for the claim.
Plaintiff HH was covered by his father’s employer-sponsored plan with Aetna Life Insurance Company. The health plan was a fully-insured plan. He has struggled with issues such as anxiety, depression, and suicide ideation. When other therapies had failed, the complaint says, his therapist recommended that he go to Open Sky Wilderness Therapy, a program licensed by that state of Colorado as a Residential Child Care Facility.
Plaintiff VG was covered by her father’s employer-sponsored plan with Aetna Life Insurance Company. The complaint claims she has struggled for years with ADHD, autism, and suicide ideation. After she had tried other therapies that did not work, the complaint says, her therapist recommended that she try Aspiro Group, a wilderness therapy program licensed by the state of Utah as an Outdoor Youth Treatment program.
In both programs, patients receive a psychiatric assessment on intake and are given individualized treatment plans. VG was treated for just under a month. HH was treated for three months.
Aetna refused to reimburse the cost of either treatment because they were rendered at “a Wilderness Treatment Program or any such related or similar program…”
The complaint protests the exclusion of these programs because it “cannot be squared with its coverage obligations as expressed by its own Plan documents.” It claims that Aetna “violates the Mental Health Parity Act by imposing a blanket exclusion for medically necessary services to treat mental health and drug addiction issues at residential treatment centers…”
Article Type: LawsuitTopic: Employment
Most Recent Case Event
Aetna Denial of Benefits for Wilderness Therapy ERISA Complaint
June 14, 2018
Two minors were denied coverage under their fathers’ Aetna health benefit plans for mental health and substance use programs, the complaint for this class action says, because of the plans had improper exclusions for licensed wilderness therapy programs and licensed residential treatment centers. Both plans are covered under the Employee Retirement Income and Security Act (ERISA) and the complaint says that the denial violates the Mental Health Parity Act, among other things.
aetna_wilderness_therapy_complaint.pdfCase Event History
Aetna Denial of Benefits for Wilderness Therapy ERISA Complaint
June 14, 2018
Two minors were denied coverage under their fathers’ Aetna health benefit plans for mental health and substance use programs, the complaint for this class action says, because of the plans had improper exclusions for licensed wilderness therapy programs and licensed residential treatment centers. Both plans are covered under the Employee Retirement Income and Security Act (ERISA) and the complaint says that the denial violates the Mental Health Parity Act, among other things.
aetna_wilderness_therapy_complaint.pdf