Aetna Class Action Challenges Wilderness Therapy Coverage Denials

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Aetna Life Insurance Co. has been hit with a class action lawsuit accusing it of denying coverage for medically necessary mental health and substance abuse service provided by licensed wilderness therapy programs and residential treatment centers.

Plaintiffs H.H. and V.G. claim that Aetna imposes a blanket exclusion for these treatments that violate the terms of its own health plans.

According to the Aetna class action lawsuit, the insurer also violates the federal Mental Health Parity Act by denying coverage for treatment at residential treatment centers, even though it provides coverage for other types of residential programs such as skilled nursing care.

V.G., who was covered under her father’s Aetna insurance plan, reportedly struggled with mental health issues like autism, ADHD and suicide ideation. After outpatient treatment and other therapies were unsuccessful, V.G.’s therapist recommended a wilderness therapy program called Aspiro Group Inc., an intermediate mental health treatment program licensed as an Outdoor Youth Treatment program by the state of Utah.

V.G.’s father sought coverage for her treatment at Aspiro from March 6, 2016 through May 4, 2016. He personally paid $28,500 for these treatment services, the Aetna class action lawsuit says.

However, Aetna denied coverage for the services provided by Aspiro on the grounds that they were rendered as “a Wilderness Treatment Program or any such related or similar program [sic] school or educational services.” V.G.’s father appealed the decision but Aetna still declined coverage.

Similarly, H.H. was covered by his father’s Aetna insurance plan and struggled with mental health issues such as anxiety, depression and suicide ideation. After outpatient treatment, hospitalization and other therapies were unsuccessful, his therapist recommended he go to Open Sky Wilderness Therapy, an intermediate mental health treatment program licensed as a Residential Child Care Facility by the state of Colorado.

H.H.’s father sought coverage for his son’s treatment at Open Sky from March 29, 2016 through June 29, 2016. He personally paid $45,105 for the treatment services, according to the Aetna wilderness therapy class action lawsuit.

However, the claims were denied because the “service requested must not be a Wilderness Treatment Program or any such related or similar program, school, and/or education service.” Aetna informed him that the residential treatment was not covered by the terms of the plan. Aetna continued to deny coverage after H.H.’s dad appealed the denial.

According to the Aetna class action lawsuit, the terms of the plaintiffs’ insurance policies included mental health residential treatment services, and there is no applicable exclusion in the policy regarding wilderness therapy.

The plaintiffs filed the Aetna class action lawsuit on behalf of themselves and a proposed Class of people insured by Aetna who were similarly denied coverage for treatment at a licensed wilderness therapy program or residential treatment center.

The plaintiffs are represented by Jordan M. Lewis of Jordan Lewis PA and Edward H. Zebersky of Zebersky Payne LLP.

The Aetna Wilderness Therapy Coverage Class Action Lawsuit is H.H., et al. v. Aetna Life Insurance Co., Case No. 9:18-cv-80773, in the U.S. District Court for the Southern District of Florida.