California Healthline (7/11, Korry) reports a class-action lawsuit filed in the District Court for the Northern District of California alleges that Blue Shield of California “wrongly restricted patients’ access to outpatient and residential mental health treatment” by developing “criteria that violate accepted professional standards and the terms of the health plan itself” along with Magellan Health Services of California.
Blue Shield said it disagrees “with the allegations in the lawsuit” and plans to “defend the case vigorously.” According to California Healthline, “The plaintiffs seek to change Blue Shield’s and Magellan’s policies to be consistent with the law, generally accepted professional standards and the terms of its own plans, according to the lawsuit.”
According to Dr. Anita Everett, president of the American Psychiatric Association, “A win in this case would mean that ‘medically necessary’ means just that, necessary as an objective medical matter not medically necessary only if not too expensive.”
Related Links:
— “Blue Shield Improperly Denied Mental Health, Drug Treatment Claims, Suit Alleges,” Elaine Korry, California Healthline, July 11, 2017.