An Illinois federal judge has denied the motion to dismiss filed by BlueCross BlueShield of Illinois and the Accenture LLP Medical Benefits Plan in a suit over mental health parity brought under the Employee Retirement Income Security Act (ERISA). In Allison B. v. BlueCross BlueShield of Ill., a parent of a minor child plan participant, M.B., filed a challenge to the insurer’s denial of coverage for wilderness therapy and inpatient mental health treatment under the Mental Health Parity and Addiction Equity Act (MHPAEA). In allowing the claim to proceed, the judge rejected the companies’ arguments that Allison B. had failed to adequately plead an MHPAEA violation in her complaint.
The basis for the suit stems from treatment that M.B. received at Open Sky Wilderness Therapy and Maple Lake Academy, licensed Utah facilities offering sub-acute inpatient treatment to adolescents for mental health and addiction disorders. After BlueCross BlueShield denied the coverage claims, Allison B. sued, alleging that the companies violated the MHPAEA by imposing more restrictive treatment limitations on mental health benefits than those applied to medical and surgical benefits.
In evaluating Allison B.’s claims, the court used a four-part test that other federal courts have used to assess whether a plaintiff has adequately pled an MHPAEA claim. This test requires a plaintiff to:
- plausibly allege that the relevant plan is subject to MHPAEA;
- identify a specific treatment limitation on mental health or substance use disorder benefits covered by the plan;
- identify medical or surgical care covered by the plan that is analogous to the mental health or substance use disorder care for which the plaintiff seeks benefits; and
- plausibly allege a disparity between the treatment limitations on mental health or substance use disorder benefits as compared to the limitations imposed upon the medical or surgical analog
BlueCross BlueShield contested the fourth prong of the test, arguing that Allison B. had failed to show a disparity between the plan’s requirements for residential treatment centers (RTCs) and skilled nursing facilities (SNFs), both of which require 24/7 onsite nursing care. However, the court disagreed, finding a disparity between the two types of facilities, in that while the plan requires 24-hour nursing care for RTCs, it requires SNFs only to be licensed by the appropriate government entity and operate within the scope of that license. Therefore, since the plan, on its face, imposes a 24-hour nursing requirement on RTCs but not on SNFs, the court denied the companies’ motion to dismiss the suit. This disparity is crucial for MHPAEA claims, since that law prevents insurers from establishing or enforcing group health plans that treat mental and medical health claims for treatment differently.
The Allison B. decision joins a growing list of cases that address whether health plans should cover wilderness therapy programs under the MHPAEA. In the March 2026 decision in Richard K. v. Illinois, another federal court noted that a plan that provides coverage for mental health services at some facilities does not overcome an MHPAEA claim if it limits treatment for mental health services differently than it limits treatment for medical and surgical services.
As the line of cases emphasizing disparate limitations continues to grow, the emphasis is not just on the availability of other types of mental health care. As a result, courts nationwide have found potential MHPAEA violations in several cases involving wilderness programs. For example, in Candace B. v. Blue Cross, a Utah federal court allowed an MHPAEA claim to proceed where a plan excluded wilderness programs only in the exclusion sections for mental health services and substance abuse treatment. Likewise, in C.M. v. Health Care Service Corp., an Illinois federal district court denied dismissal of an MHPAEA claim where the plan’s definition of residential treatment center contained a specific exclusion of wilderness programs from coverage.
However, not all courts have come out in favor of wilderness program coverage under the MHPAEA. For instance, in O.F. v. Health Care Serv. Corp., an Illinois federal district court granted the plan’s motion to dismiss mental health parity claims, although it gave the plaintiff leave to refile them. In this case, the court disagreed with the plaintiff’s argument that wilderness treatment exclusions are inherent MHPAEA violations since there is no comparable medical or surgical treatment. The court reasoned that non-therapeutic care was excluded from both mental health and medical/surgical benefits, and the plaintiff failed to present evidence that the program was primarily therapeutic. The lack of evidence led to the court finding of no plausible MHPAEA violation.
A great deal of MHPAEA litigation centers on non-quantitative treatment limitations (NQTLs), particularly when suits challenge restrictions based on facility type and the criteria defining medical necessity. The MHPAEA requires that plans imposing NQTLs on mental health or substance use disorder benefits must engage in and document their comparative analyses of the design and application of NQTLs. The required documentation is quite extensive, including a detailed explanation of any findings involving NQTLs, and a full description of the criteria for approving both medical and surgical benefits and mental health and substance use disorder benefits.
Many parity cases, including Allison B., use 29 U.S.C.S. §1132(a)(3) to seek equitable relief for ERISA violations. The Tenth Circuit has allowed plaintiffs to use this section in MHPAEA claims, finding them to be “viable.” Because the MHPAEA does not create a private right of action, plan participants alleging MHPAEA violations must rely on ERISA’s existing enforcement provisions. The availability of equitable relief allows plaintiffs to compel plans to comply with parity requirements in the future and to seek damages for denied benefits.
As a result of this steadily evolving line of cases, plan sponsors and administrators should ensure that, if their plans impose restrictions based on facility type, medical necessity criteria, or other NQTLs on mental health benefits, the plans also impose comparable restrictions on medical/surgical benefits. Plans can meet these requirements by performing MHPAEA-prescribed NQTL analyses and documenting the process and all factors used to apply NQTLs to mental health and medical/surgical benefits. The plans should also identify analogous medical facilities for residential treatment centers, mental health facilities, and wilderness programs, if they wish to impose specific requirements on coverage for that type of treatment and establish comparable requirements for those facilities.
Furthermore, plans that wish to exclude certain kinds of mental health treatment must establish comparable exclusions for medical treatment. If the exclusions appear only in plan documents related to mental health treatment, they could be vulnerable to MPHAEA challenges. As plans make these crucial coverage decisions, they must maintain detailed documentation of how they developed and applied NQTLs and standards used to determine medical necessity. Finally, if plan participants request plan documents and other plan information to assess parity, plans should comply, as courts have not looked favorably on plans’ refusal to provide this information to participants.
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