Lawsuit: Marsh & McLennan Unlawfully Denies Mental Health Treatment

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Marsh & McLennan Companies, Inc., its Benefits Administration Committee, its Health & Welfare Benefits Program, and Aetna Life Insurance Company are the defendants in a proposed class action lawsuit filed by two parents on behalf of their minor daughter. The suit alleges that the plaintiffs’ daughter sought medically necessary treatment at an out-of-network residential psychiatric treatment facility, but was unlawfully denied coverage under her insurance plan. The defendants insisted that the daughter’s treatment was “administratively excluded” from covered options because the facility she chose allegedly did not meet “staffing and credentialing” required by the plan, according to the complaint. The suit argues that this exclusion was unlawful because it was not disclosed in the plan document and it violated several laws instated to protect consumers’ rights regarding mental health.

The suit cites the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (also known as the Federal Parity Act), which allegedly states that limitations and exclusions applied to mental health services can be “no more restrictive” than those applied to medical/surgical treatments. It argues that the plan does not exclude similar medical and surgical services, “such as skilled nursing facilities.”

The lawsuit further claims that the defendants violated the Affordable Care Act by “discriminating” against a facility that “is acting within the scope of the provider’s license under applicable state law.”

According to the complaint, the defendants’ decision to exclude treatment of the plaintiffs’ daughter under their insurance plan was “arbitrary and capricious,” and caused the plaintiffs to pay out-of-pocket expenses for the care of their daughter.