Anthem Blue CrossFacing Class Action For Denying Mental Health Coverage

The caretaker of a woman suffering from severe mental illness has filed a bad faith class action lawsuit against Anthem Blue Cross for allegedly discriminating against mentally ill claimants in violation of California law.

Plaintiff Pamela Banken initiated this bad faith insurance lawsuit on behalf of her daughter Marie. Marie suffers from schizophrenia and obsessive compulsive disorder. Her mental illness is severe enough that in April 2014, a local commissioner found her “gravely disabled” and placed her in conservatorship under her mother’s care.

At issue is Marie’s insurance coverage for inpatient psychiatric hospitalization that began in March 2014. At the time of her admission, Marie was a member of an Anthem Blue Cross PPO Share policy.

Her psychiatrist submitted requests for authorization of coverage to Anthem. Anthem approved coverage for up to eleven days of hospitalization but then denied further coverage on the grounds that more hospitalization was not necessary.

Following that denial, Banken paid about $26,000 out of pocket for Marie’s hospitalization. At the time Banken filed her bad faith insurance lawsuit, Marie had been hospitalized for more than 115 days, only 11 of which had been covered by Anthem Blue Cross. Since then, Banken says, Marie’s continuing hospitalization has been paid for using Marie’s federal SSI income and Banken’s own money.

Challenging the Standards Used by Anthem Blue Cross

Banken is challenging not just the denial of coverage for Marie but also the standards that Anthem Blue Cross uses to deny claims for mental health coverage. She claims that Anthem Blue Cross “intentionally discriminated against plaintiff and other Anthem members and subscribers with psychiatric disorders on the sole basis that they suffer from a severe mental illness.”

She alleges Anthem Blue Cross’s actions violate California’s Mental Health Parity Act, which requires health insurers to cover mental illnesses under the same terms and conditions under which physical illnesses are covered.

Banken also alleges that Anthem Blue Cross did not provide a competent review of the request for coverage. She cites deposition testimony from the doctor who signed her denial letter, who said that he allowed Anthem Blue Cross to affix his electronic signature to their letters without his ever having read them. The doctor said he allowed this use of his signature even though he had no participation in the benefit determination, nor did he take any part in writing the denial letter.

Banken also seeks $4,000 for each alleged violation of California’s Unruh Act, which prohibits discrimination based on certain medical conditions. The rest of her bad faith insurance lawsuit alleges fraud, contractual violations, and violations of the California Unfair Competition Law.

This bad faith lawsuit was initiated as a putative class action lawsuit. Banken proposed a plaintiff class defined as all California residents who are members of an individual Anthem Blue Cross PPO plan, who have been diagnosed with a “Severe Mental Illness” listed in the California Mental Health Parity Act, who have been placed in a conservatorship, and requested benefits for psychiatric treatment, and whose requests were subject to Anthem Blue Cross’s psychiatric guidelines.

Banken initiated this bad faith insurance lawsuit in June 2014.

The Bad Faith Insurance Class Action Lawsuit is Pamela Banken v. Anthem Blue Cross Life & Health Insurance Co., Case No. BC550193, in the Superior Court of the State of California, County of Los Angeles.

Join a Free California Bad Faith Insurance Lawsuit Investigation

A bad faith lawsuit investigation has been launched into allegations that some California insurance companies are refusing to pay valid medical claims or offering to pay far less than the claim is worth. Some of the companies being investigated for potential violations include:

• Aetna
• Anthem Blue Cross
• Blue Cross of California
• Blue Shield of California
• Cigna
• Health Net
• Kaiser
• Secured Horizons
• United Healthcare
• WellPoint
• Others

If you or a loved one were denied coverage for autism treatment, mental health treatment, plastic surgery skin removal after weight loss, proton therapy for cancer, or some other medically necessary treatment, you may have a legal claim.

Get a Free Case Evaluation Now