M.D. (a minor) was denied health benefits by Aetna for a wilderness treatment program, Aspiro, and a transitional living program, Dragonfly. Aetna moved for judgment on the pleadings arguing that the language of the self-funded ERISA plan it was administering excluded coverage for these two types of treatment for mental health and substance use disorders. In response, we argued that the Plan terms were inconsistent: they provided coverage for “medically necessary” treatment for mental health and substance use disorders yet excluded coverage for wilderness treatment and transitional living, even when that treatment was medically necessary. We also asserted that by denying coverage, the Plan violated the federal Mental Health Parity and Addiction Equity Act (“MHPAEA”). The court denied Aetna’s motion and ordered that the case proceed to be heard on the merits after discovery on the MHPAEA claim.
Posted on Jul 11, 2019