ConAgra and Blue Cross Sued in ERISA Class Action Lawsuit

A proposed ERISA class action lawsuit has been filed against ConAgra Foods Inc. and Blue Cross Blue Shield in California court, alleging the companies denied individuals diagnosed with autism spectrum disorder behavioral therapy treatment, thus allegedly violating the Employment Retirement Income Security Act (or ERISA) as well as mental health laws set forth by the state and federal governments.

Plaintiff Gabrielle Raygoza is a ConAgra employee who is covered under the company-provided Blue Cross health plan, a plan which supposedly includes mental health treatment. However, according to her ERISA class action lawsuit, Blue Cross Nebraska wrongfully denied her claim for her son’s applied behavior analysis therapy. She further alleges ConAgra and Blue Cross’ practices violate state and federal mental health parity acts as well as ERISA statutes.

Raygoza’s 5-year-old son is considered a beneficiary under the ConAgra-provided Blue Cross plan. Raygoza claims that Blue Cross has a duty to provide a certain level of care under their health plans and that these plans meet generally accepted physical and mental health standards. According to the ConAgra Blue Cross ERISA class action lawsuit:

“BCBS [BlueCross Blue Shield] breached this duty by supplanting generally accepted treatment standards in the mental health field with standards that promote the self-serving, cost-cutting preferences of BCBS and its corporate affiliates. By adopting guidelines that are inconsistent with, and much more restrictive than, those that are generally accepted in the medical community, BCBS breached its fiduciary duty to act solely in the interests of participants and beneficiaries for the ‘exclusive purpose’ of ‘providing benefits’ with reasonable ‘care, skill, prudence, and diligence’ and in accordance with Plaintiffs’ Plans.”

According to the ConAgra Blue Cross class action lawsuit, the plaintiff’s son had received ABA therapy at a mental health facility in 2013. This type of therapy, which systematically helps an individual work in improving reading, academics, social and living skills, was covered by and paid for by a different Blue Cross plan.

In June 2013, Raygoza’s employer, ConAgra, switched to BlueCross Nebraska, which only covered the plaintiff’s son’s ABA therapy until December of that year. At the start of the 2014 year, Raygoza claims she contacted Blue Cross who confirmed for her that the ABA therapy was covered at a 90 percent coinsurance after a deductible was met. During these communications, the insurance company also confirmed for the plaintiff that the mental health facility where her son was being treated was an in-network provider and the facility itself confirmed this fact with Blue Cross.

Raygoza’s son continued to receive treatment for two months into the 2014 year. However, according to the ERISA class action lawsuit, when the plaintiff attempted to be reimbursed by the company, her claim was denied by Blue Cross, who stated the reported therapy services were excluded. No further information was provided to Raygoza. The plaintiff appealed her claim and was again denied by Blue Cross in May of that year.

In this ConAgra Blue Cross class action lawsuit, Raygoza seeks to represent herself, as well as a Class that would include:

“All participants or beneficiaries in an insurance plan governed by ERISA, for which BCBS, BCBS Nebraska or any other independent Blue Cross and Blue Shield independent entities have been delegated the authority to make coverage decisions with respect to claims for mental health treatment, who sought and were denied coverage for all or a portion of applied behavioral analysis or ABA Therapy, within the applicable statute of limitations.”

The plaintiff is seeking relief in the form of injunctions stopping Blue Cross from continuing to deny ABA therapy claims based on their own guidelines and to adopt claim guidelines that are more generally accepted by state laws. She also seeks an injunction forcing the insurer to provide coverage for ABA therapy for its members like her son, among other forms of relief.

The plaintiffs are represented by Glenn R. Kantor and Timothy J. Rozelle of Kantor & Kantor LLP.

The ConAgra Blue Cross ERISA Class Action Lawsuit is Raygoza, et al. v. ConAgra Foods Inc. Medical Plan, et al., Case No. 2:15-cv-03741, in the U.S. District Court for the Central District of California.