A self-insured health plan participant sued the plan and plan administrator after receiving denials of his claims for his child’s residential mental health treatment. The participant claimed that Anthem Blue Cross and Blue Shield violated the Mental Health Parity and Addiction Equity Act (MHPAEA) for imposing a treatment limitation on mental health/substance use disorder (MH/SUD) benefits that it did not impose on medical/surgical benefits.
The plan administrator moved to dismiss the participant’s claim, arguing that the participant had failed to identify medical/surgical care analogous to residential mental health care or allege how the plan treated medical/surgical and mental health services differently.
The district court judge denied Anthem’s motion to dismiss, finding that the participant’s alleged analogy between residential mental health care and medical/surgical care at a skilled nursing or rehabilitation facility was sufficient, at least at this stage of the litigation. The court further held that the participant had met the burden sufficient for the case to proceed beyond the motion to dismiss to the discovery stage.
In its decision, the court noted that other courts were permitting mental health parity claims to progress to discovery, as information about how insurers process mental health claims lies only with the insurers. Courts allow mental health parity claims to rest on facially disparate or “as-applied” disparate claims, such as in this case. As a result, mental health parity claims are becoming increasingly more expensive for insurers to defend, as they are unlikely to be dismissed at the initial stage of a lawsuit.
The case is T.E. v. Anthem Blue Cross and Blue Shield, 3:22-cv-202-DJH-LLK (W.D. Kentucky 2023).
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.
Hall Benefits Law, LLC
Latest posts by Hall Benefits Law, LLC (see all)
- Fifth Circuit Considers Arbitration Clause in ERISA Claim - March 20, 2026
