Magistrate Recommends Finding That Could Invalidate Insurer’s RTC Exclusion

January 2020 | News

In L.P. v. BCBSM, Inc., No. 18-cv-1241 (D. Minn. January 17, 2020), a magistrate has recommended a finding that, if affirmed, could result in a finding that Blue Cross of Minnesota’s residential treatment center coverage exclusion violates the federal Parity Act. In the decision, the Magistrate found that Blue Cross’s exclusion – which denied coverage for services rendered at any residential treatment center if that center provided “non-incidental” educational services – “creates a disparity in coverage for facility-related fees and services” because there was no comparable exclusion for comparable medical surgical services. “[O]nly residential behavioral health treatment facilities lose all eligibility for coverage by providing such uncovered services more ‘than incidentally.’ ” The Magistrate held off on a final ruling, however, instead ordering the case to be remanded back to the plan administrator so that the plaintiff could add additional facts to the record. The plaintiff here is represented by Jordan Lewis, P.A. and Lockridge Grindal Nauen PLLP.

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