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Family Wins Penalties, Mental Health Parity Suit Against Premera

Aug. 11, 2021, 4:42 PM

Premera Blue Cross violated federal mental health parity law when it used a rubric called the InterQual Criteria to gauge the medical necessity of a teenager’s mental health treatments, a federal judge in Utah ruled.

The teenager’s family argued that Premera denied coverage for his stay at Daniels Academy by applying medical necessity criteria that are external to the relevant health plan document, despite using only the plan document to determine whether treatments at inpatient hospice facilities are medically necessary.

This violates the Mental Health Parity and Addiction Equity Act, the federal law requiring mental health benefits to be covered ...