United Policyholders Jumps Into Appeal Over $800-Per-Day Care

Administrators of ERISA-covered health plans have a legal duty to seek out “readily-available medical evidence” when considering a claim for benefits, a nonprofit group representing insurance consumers told a federal appeals court.

United Policyholders wants the court to overturn a decision in favor of a health insurer that declined to cover nearly $100,000 in medical bills for a college student who spent four months at an $800-per-day treatment facility. The group says Harvard Pilgrim Health Care violated the Employee Retirement Income Security Act when it denied coverage because the insurer didn’t seek out readily available medical information supporting the student’s ...