Kaiser Class Action Says Eating Disorder Treatment Unlawfully Denied

Editor’s note: This story has been edited pursuant to redacted court documents.

A California man says Kaiser has been unlawfully denying coverage for residential treatment to persons with eating disorders.

Plaintiff Ian Moura claims defendant Kaiser Foundation Health Plan Inc. has been systematically denying coverage for the treatment of eating disorders.

Terms of the Kaiser health plan prevent physicians from authorizing medically necessary residential treatment, allegedly in violation of state and federal law.

According to Moura’s Kaiser class action lawsuit, anorexia nervosa is the deadliest of all mental disorders, with a mortality rate of 20 percent.

Moura reports that anorexia can lead to dangerous and deadly secondary conditions including “cardiac arrhythmia, heart failure, kidney stones and kidney failure, cognitive impairment, osteoporosis,” and other complications. Depression and suicide are not uncommon among anorexia patients, Moura says.

These disorders are treatable, according to the Kaiser class action lawsuit. Yet Moura’s Kaiser-administered health plan unlawfully bars physicians from authorizing medically necessary residential treatment, he claims.

Moura is diagnosed with anorexia nervosa. Several doctors have recommended inpatient psychiatric hospitalization for Moura. Yet Kaiser, which administers the group health plan provided by Moura’s employer Fujitsu, repeatedly denied that coverage, Moura says. His anorexia eventually became so severe that he was hospitalized several times in 2014.

Kaiser’s failure to cover treatment for eating disorders is contrary to applicable laws, Moura claims. Both California and federal laws require insurance coverage for mental disorders to be administered on par with coverage provided for medical and surgical needs.

Moura also cites the California Medical Practices Act, which prohibits corporate entities like insurance companies from making the kinds of professional judgments that should properly be left to an individual physician.

This Kaiser class action lawsuit raises two claims under the federal Employee Retirement Income Security Act, or ERISA. This law governs the administration of several different kinds of employment benefits, including employer-sponsored group health insurance plans like the Kaiser plan at issue here.

Moura seeks to bring this Kaiser class action lawsuit on behalf of all persons covered by an ERISA-governed Kaiser health plan that was issued, amended or renewed within California on or after July 1, 2000, who were diagnosed with anorexia nervosa or bulimia nervosa within the applicable statutory limitations period.

He seeks a declaration by the court that Kaiser’s policy of failing to cover residential treatment of eating disorders violates applicable state and federal laws, and therefore violates ERISA. He is asking the court to order Kaiser to pay for such treatment, notwithstanding any policy language excluding such treatment for coverage.

Mouna’s attorneys are Lisa S. Kantor and J. David Oswalt of Kantor & Kantor LLP and Kathryn M. Trepinski of the Law Offices of Kathryn M. Trepinski.

The Kaiser Eating Disorder Treatment Coverage Class Action Lawsuit is Ian Moura v. Kaiser Foundation Health Plan Inc., Case No. 3:17-cv-02475, in the U.S. District Court for the Northern District of California.