Kantor & Kantor, LLP Announces Ruling That Health Plans Must Cover Residential Treatment for Eating Disorders

LOS ANGELES, June 5, 2012 /PRNewswire/ -- Kantor & Kantor, LLP announced today that the Ninth U.S. Circuit Court of Appeals has denied an insurer's request for rehearing of a significant victory for people suffering from nine enumerated mental health conditions – eating disorders in particular. The Court confirmed its August 26, 2011 decision that the California Mental Health Parity Act requires health plans to provide coverage of "all medically necessary treatment" for "severe mental illnesses" under "the same financial terms as those applied to physical illnesses." In the latest decision, Harlick v. Blue Shield of California, the court held that health plans in California are obligated to pay for residential treatment for people with eating disorders even if the policy excludes residential treatment.

"We appreciate that the Court not only denied Blue Shield's request for rehearing and rehearing en banc but also issued a new opinion with added clarity about the broad scope of California's Mental Health Parity Act," said Lisa Kantor of Kantor & Kantor, LLP, who represents the plaintiff Jeanene Harlick.  "The majority opinion takes a common sense approach in interpreting the Act and accomplishes the legislative purpose of mandating full coverage for severe mental illnesses."

Jeanene Harlick has suffered from anorexia for more than 20 years. In 2006, her physicians recommended treatment at a facility qualified to treat eating disorders.  Although Blue Shield agreed to pay for the treatment, after 10 days it denied coverage, saying the plan did not cover residential treatment even though the insurer agreed the treatment was medically necessary. 

In July 2008, Kantor sued Blue Shield on Harlick's behalf, arguing among other things, that Blue Shield's health plan violated the California Mental Health Parity Act. Blue Shield argued that it had discretion to deny coverage, and the district court agreed. Harlick appealed, and the Ninth Circuit ruled in her favor. Blue Shield requested a rehearing and a rehearing en banc (before all judges of the Ninth Circuit).  The briefing on these requests was completed in November 2011.  The California Department of Insurance filed a Brief of Amicus Curiae (friend of the Court), opposing Blue Shield's requests and supporting Harlick's position.  The Department of Managed Healthcare did not file a similar brief in the matter, despite its responsibility for regulating health care service plans in California. 

For more information about Lisa Kantor and legal assistance for eating disorders, follow this link: http://www.kantorlaw.net/Areas_of_Practice/Eating_Disorders.aspx.

About Kantor & Kantor, LLP   

Kantor & Kantor is one of the largest law firms in the country exclusively representing plaintiffs who have been denied insurance benefits under life, health, disability and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters, as well as the handling of Insurance Bad Faith matters.  For more information, log on to www.kantorlaw.net, call (800) 446-7529, or follow the firm at www.californiainsurancelawyerblog.com.

SOURCE Kantor & Kantor, LLP