Aetna Settles ERISA Suit Over Underpaid and Unpaid Mental Health and Substance Abuse Treatment Claims

Aetna Life Insurance Company (Aetna) has settled an ERISA claim with a woman who claimed that it underpaid or failed to pay claims related to her mental health care and substance abuse disorder treatment. The parties reached a settlement agreement several months after a federal district court granted partial summary judgment in favor of the plan beneficiaries, finding that Aetna had violated the terms of the health plan’s medical necessity criteria. 

The judge ruled that Aetna had used inconsistent reimbursement rates for one treatment facility and denied coverage completely for the other facility, which was a transitional program. In doing so, the judge concluded, Aetna violated federal law. The judge dismissed the beneficiaries’ federal mental health parity law claim. 

Health plan beneficiaries Alan R. and his daughter, J.R., originally sued Aetna in April 2020 in R. et al. v. Aetna Life Insurance Company et al., case number 3:20-cv-00441, U.S. District Court for the Western District of North Carolina. They claimed that Aetna had abused its discretion under ERISA by denying claims for mental health care for J.R., who had a history of mental health and substance use disorders, at two Texas facilities. 

HBL has experience in all areas of benefits and employment law, offering a comprehensive solution to all your business benefits and HR/employment needs. We help ensure you are in compliance with the complex requirements of ERISA and the IRS code, as well as those laws that impact you and your employees. Together, we reduce your exposure to potential legal or financial penalties. Learn more by calling 470-571-1007.

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HBL offers employers comprehensive legal guidance on benefits in mergers and acquisitions, Employee Stock Ownership Plans (ESOPs), executive compensation, health and welfare benefits, healthcare reform, and retirement plans. We counsel a wide spectrum of clients including small, mid-sized, and large companies, 401(k) investment advisors, health insurance brokers, accountants, attorneys, and HR consultants, just to name a few. HBL is passionate about advising clients, and we are dedicated to our mission: to provide comprehensive, personalized, and practical ERISA and benefits legal solutions that exceed client expectations.
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