Blue Shield Must Pay for Some Out-of-Area Mental Health Care

Parents convinced a federal court that Blue Shield of California must pay for some of their child’s out-of-area residential mental health care under the Employee Retirement Income Security Act.

Blue Shield argued that it wasn’t required to pay for A.Z.'s care under the out-of-area exclusion in the two applicable benefit plans, but Judge Araceli Martínez-Olguín granted Michelle and Bo Z.'s motion for summary judgment Dec. 26, saying coverage was proper on the ERISA claim under the plans’ medically necessary provisions, but state law claims must be decided by a jury.

One of the applicable plans was an individual family plan ...