Regence BlueShield, Cambia Must Face Wilderness Therapy Class Action

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Insurance holders will be able to move forward with their class account lawsuit claiming that Regence BlueShield and Cambia Health Solutions should have covered wilderness therapy treatment, after a Washington federal judge denied the heath insurance companies’ bid to dismiss the case.

On Thursday, U.S. District Court Judge Thomas S. Zilly determined that the insurance companies’ language describing what was covered and what was not did indeed include wilderness therapy, a form of therapy used to help with mental and emotional health issues, as well as behavioral problems.

Judge Zilly reached this determination despite Regency BlueShield and Cambia Health’s efforts to claim that their insurance policies do not cover wilderness therapy.

As a result of this decision, two parents will be able to advance their class action lawsuit that they filed in 2017 when their daughter was denied coverage for her wilderness therapy, a treatment they were hoping would improve their daughter’s depression and other mental health issues. The parents had sought coverage for their daughter’s stay at Evoke Therapy Programs, a residential wilderness therapy treatment facility.

The parents aim to represent themselves as well as other policyholders who had coverage for wilderness therapy denied under their Regence BlueShield and Cambia Health Solutions insurance plans.

Judge Zilly determined that the insurance plans did in fact cover wilderness therapy because the plan will cover stays at residential treatment centers for mental health issues.

Though Regence attempted to claim that Evoke did not count as a residential treatment facility because the treatment was mostly held outdoors, Judge Zilly found that the plan’s language about what constituted a facility was not as restrictive as the company had argued in court.

“The court disagrees with defendants’ myopic view of what a ‘wilderness program’ is and, for purposes of resolving the instant motion, concludes that A.Z. has plausibly alleged that Evoke is a facility within the definition of residential care,” Judge Zilly determined.

In their health insurance coverage class action lawsuit, the patient and her parents also alleged that the companies’ refusal to cover wilderness therapy represented a violation of the Mental Health Parity and Addition Equity Act of 2008. This Act requires health care providers to provide roughly the same coverage for mental health claims as they do for physical health and surgical claims.

Judge Zilly agreed that the patient and her parents had made this argument convincingly enough to let the case, and this claim specifically, continue to move forward.

The judge also preserved most of the patient and her parents’ claims, except one allegation that alleged that Regence and Cambia, the nonprofit parent of the insurers had breached fiduciary duties to insurance holders by denying wilderness therapy claims.

In opposition to this claim, Judge Zilly argued that the patient and her parents had not shown that the lack of coverage for wilderness therapy had caused a loss to the value of the plan itself.

The patient and her parents are represented by Eleanor Hamburger and Richard E. Spoonemore of Sirianni Youtz Spoonemore Hamburger and Jordan Lewis of Jordan Lewis PA.

The Regence BlueShield, Cambria Health Solutions Wilderness Therapy Coverage Class Action Lawsuit is A.Z., et al. v. Regence BlueShield, et al., Case No. 2:17-cv-01292, in the U.S. District Court for the Western District of Washington.

UPDATE: On Jan. 10, 2019, plaintiffs secured a settlement for their class action lawsuit alleging that Regence BlueShield and Cambia Health Solutions failed to provide wilderness therapy coverage.