Insurance Commissioner Files Brief Supporting Mental Health Ruling

On Thursday, Insurance Commissioner Dave Jones (D) filed an amicus brief supporting a federal court panel's decision that California's Mental Health Parity Act requires health insurers to fully cover certain severe mental health conditions, Lake County News reports (Lake County News, 11/10).

Background

In August, a panel of three judges from the 9th U.S. Circuit Court of Appeals in San Francisco ordered Blue Shield of California to pay for a policyholder's anorexia treatment, saying the treatment falls under provisions of California's Mental Health Parity Act of 1999.

The panel ruled that the parity act requires insurers to provide the same coverage for severe mental health conditions as for physical conditions. The decision overturned a lower court's ruling in the case.

The judges said all health plans within the scope of the act must cover medically necessary treatments for nine mental health conditions:

  • Autism or pervasive developmental disorder;
  • Bipolar disorder;
  • Eating disorders;
  • Major depression;
  • Obsessive-compulsive disorder;
  • Panic disorder;
  • Schizoaffective disorder;
  • Schizophrenia; and
  • Serious emotional disturbances in children and adolescents.

The court ordered Blue Shield to pay for the policyholder's nearly 10-month anorexia treatment at a residential care facility, even though her policy did not include the coverage (California Healthline, 9/6).

Blue Shield is appealing the case (California Healthline, 10/14).

Details of the Brief

The insurance commissioner's brief was filed in the context of Blue Shield's appeal to the full circuit court to overturn the panel's decision.

Jones said he strongly supports the panel's ruling.

"Individuals suffering from mental illnesses have long faced disparity in the coverage they receive from their insurers, and the time is now to end this practice," Jones noted in a release.

He added that health insurers have an obligation to abide by the parity act (Lake County News, 11/10).


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