Blue Shield Mental Health Claim Denial Upheld by Ninth Circuit

Blue Shield of California’s refusal to cover about $225,000 in medical bills tied to teenager’s stay at a residential mental health treatment center was upheld by the Ninth Circuit.

Blue Shield—formally known as California Physicians’ Service—didn’t abuse its discretion in deeming the child’s care medically unnecessary under its stated coverage criteria, the US Court of Appeals for the Ninth Circuit said Tuesday. The insurer consulted with an independent physician and relied on contemporaneous medical records, the court said in an unpublished opinion from Senior Judge Carlos T. Bea and Judge Danielle J. Forrest.

• The insurer wasn’t required to credit ...