Anthem Blue Cross Class Action: Insurer Must Cover Eating Disorders

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A California woman is challenging an Anthem Blue Cross claim denial, alleging the company wrongly denies coverage for eating disorder treatment.

Plaintiff Aurora Bailey says Anthem Blue Cross wrongfully refused to cover her claim for residential treatment for her diagnosed eating disorder.

In her Anthem Blue Cross class action lawsuit, she claims this denial violates the terms of her health insurance policy as regulated by the federal Employee Retirement Income Security Act, or ERISA, and the California Mental Health Parity Act.

She also alleges that Anthem’s Utilization Review Program, the program through which she says her claim was denied, fails to comply with California’s Unruh Civil Rights Act and Medical Practices Act.

Bailey says she suffers from anorexia nervosa and major depressive disorder.

She says her anorexia first set in when she was 15 years old, resulting in severe weight loss, malnutrition, and physical injury. Her over-exercising and restricted food intake led to tendonitis, orthostatic hypotension and severe migraines.

The plaintiff claims she also developed depression and anxiety severe enough to result in sweating, crying and a racing heart.

By the spring of 2014, Bailey says her condition had so deteriorated that she got recommendations for residential eating disorder treatment from her caseworker, her therapist, her physician, her dietician, and her coach.

After being formally diagnosed with an eating disorder, she was admitted to a treatment center in May 2014.

Bailey says that Anthem Blue Cross covered her residential treatment at first, but only for five days at a time.

In mid-June 2014, Bailey claims Anthem Blue Cross denied any further coverage citing its 2014 “medical necessity” guidelines for eating disorders.

Her appeal was also denied a few days later.

Because of that denial, Bailey says she had to pay out-of-pocket for the remainder of her residential treatment, running up a total bill of over $75,000.

In her Anthem Blue Cross class action lawsuit, Bailey proposes to represent a plaintiff Class consisting of all persons covered under an ERISA-governed health plan issued or renewed in California after July 1, 2000 who were diagnosed with any of a list of certain eating disorders or co-occurring mental disorders and whose claims for coverage were processed through Anthem Blue Cross’s Utilization Review Program. She also proposes a subclass of Class Members whose claims ended up being denied.

The plaintiff is asking the court for a declaration that Anthem Blue Cross’s Utilization Review Program and its guidelines violate the law.

She seeks an injunction requiring Anthem Blue Cross to pay benefits for treatment of the eating disorders and mental disorders at issue according to the applicable California benefit plans, notwithstanding any provisions or guidelines of the Utilization Review Program that purport to exclude such coverage. She is also asking for disgorgement of profits and reimbursement of attorneys’ fees and costs of litigation.

Bailey is represented by attorneys Lisa S. Kantor and J. David Oswalt of Kantor & Kantor LLP; and by Kathryn M. Trepinski of the Law Offices of Kathryn M. Trepinski.

The Anthem Blue Cross Eating Disorder Denial Class Action Lawsuit is Aurora Bailey v. Anthem Blue Cross Life and Health Ins. Co., et al., Case No. 3:16-cv-04439, in the U.S. District Court for the Northern District of California.