Kantor & Kantor LLP: U.S. Supreme Court Declines Blue Shield's Request to Overturn Ninth Circuit Ruling Requiring Health Plans to Cover Residential Treatment for Eating Disorders

LOS ANGELES, March 5, 2013 /PRNewswire/ -- Kantor & Kantor LLP announced today that the U.S. Supreme Court denied Blue Shield of California's petition for writ of certiorari, successfully ending Jeanene Harlick's nearly eight-year struggle to obtain benefits for residential treatment for her eating disorder. In denying to hear the case, the Court let stand a June 2012 Ninth U.S Circuit Court of Appeals ruling 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," even if the policy excludes residential treatment.

"Health plans should give all the reasons for a denial of benefits at once, rather than waiting years to inform policyholders of new reasons for the initial denial," said Harlick's lawyer Lisa Kantor. "Blue Shield never questioned the medical necessity of Harlick's treatment at the outset, but argued it had the right to do so after it became aware California law invalidated its policy language denying treatment. Under that theory, policyholders would be forced to wait years for recovery as insurers work through their list of reasons to deny coverage."

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 properly denied coverage under the terms of the plan, 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.  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 brief in the matter, despite its responsibility for regulating health care service plans in California. 

On June 4, 2012, the Court denied the request for rehearing and rehearing en banc, withdrew its prior opinion of August 26, 2011, and issued a majority opinion by Judge William A. Fletcher with a dissenting opinion by Judge N.R. Smith.  Blue Shield immediately filed another request for rehearing and rehearing en banc, which was denied by the Court. After that, Blue Shield petitioned the U.S. Supreme Court.

The case is California Physicians' Service dba Blue Shield of California v. Harlick, U.S. Supreme Court, No. 12-457.

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