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Comcast and their insurer have been accused of wrongfully denying insurance claims for outdoor therapy, despite their obligations under federal law.
According to a former employee who filed her class action lawsuit under the pseudonym Su Be, Comcast and Magellan Health Services Inc. refused to cover her daughter’s wilderness outdoor therapy programs despite covering “comparable” options at nursing homes and rehab facilities.
Su Be says that these actions violated the Mental Health Parity and Addiction Equity Act. This federal law is part of the Employee Retirement Income Security Act and prohibits insurance plans from unfairly restricting coverage of mental health services in comparison to general medical services.
“Comcast’s health insurance plans exclude from coverage medically necessary services rendered at wilderness therapy programs while expressly covering comparable medically necessary services,” the lawsuit said. “This disparate treatment for comparable services results in Comcast being out of parity.”
Su Be says that she worked for NBC – now owned by Comcast – from 1985 to 2017 and was covered by a COBRA health insurance plan.
Her daughter, referred to as So Be in the complaint, was adopted from Russia when she was 20 months old after being neglected by her biological parents. When she was 14, So Be was reportedly diagnosed with several mental health disorders including generalized anxiety disorder.
Su Be claims that these disorders resulted in eating disorders, suicide ideation, and severe depression. Due to these severe issues, So Be’s doctors reportedly recommended that she be enrolled in inpatient wilderness outdoor therapy.
According to Psychology Today, wilderness therapy uses adventure experiences to engage clients in cognitive and behavioral ways. Through these therapies, patients may be able to make progress where regular talk therapy hasn’t worked.
In fact, meta-analysis of 197 studies reportedly showed that outdoor therapy has a greater short-term effect than alternative therapies or no treatment. In “graduates,” this growth is often maintained.
So Be was treated at an outdoor therapy location from July 2017 to September 2017, resulting in Su Be being charged more than $29,000 for the services. Unfortunately, when Su Be submitted her coverage claim to Comcast, Magellan denied the claim.
After appealing this denial, the companies reportedly told Su Be that the outdoor therapy services were not covered under her health plan. However, Su Be argues that this is not true based on her health plan’s terms.
Comcast’s coverage plan reportedly says that the company will cover medically necessary inpatient mental health treatments, including: “[l]odging and dietary services;” “[p]hysician, psychologist, nurse, counselor and trained staff services;” “[f]amily, group and individual therapy and counseling;” “[p]artial hospitalization;” and “[f]acility-based day/night care.” Under these terms, Su Be argues that her daughter’s outdoor therapy should have been covered.
“Plaintiff’s coverage request for medically necessary mental health services were denied on the strength of a plan exclusion for such services,” Su Be argues in her Comcast outdoor therapy class action lawsuit.
“The plan expressly covers comparable medical services rendered at skilled nursing facilities and rehabilitation hospitals.”
By denying her coverage for her daughter’s mental health services, Su Be says that Comcast and Magellan are in violation of the Mental Health Parity and Addiction Equity Act.
Su Be seeks to represent a Class of consumers insured by Comcast whose outdoor therapy coverage was denied within the last six years. She also seeks to represent another Class of similar consumers whose self-funded ERISA health insurance plans were administered by Magellan and who had their claims for outdoor therapy denied within the last six years.
Did your insurer refuse to cover outdoor therapy? Share your experiences in the comment section below.
Su Be and the proposed Class are represented by Amanda Peterson of Morgan & Morgan.
The Comcast Outdoor Therapy Class Action Lawsuit is Be v. Comcast Corporation, et al., Case No. 1:20-cv-08571, in U.S. District Court for the Southern District of New York.
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