California Court of Appeal issues reversal and orders necessary mental health treatment to be covered by insurers
News: 2014 Press Release
LOS ANGELES, Calif. - Insurance Commissioner Dave Jones today issued the following statement regarding Marissa Rea v. Blue Shield of California, in which the California Court of Appeal held that Blue Shield must provide all medically necessary treatment for those suffering from severe mental illnesses. Commissioner Jones submitted both a brief and oral argument in support of Ms. Rea's claim for mental health coverage.
"The California Court of Appeal upheld the right of those suffering from severe mental illnesses to receive medically necessary treatments, even if insurers do not provide those treatments for physical illnesses. The court correctly concluded that California's Mental Health Parity Act recognizes that unique treatments are needed for mental illnesses and that those suffering from mental illness cannot be restricted to treatment models appropriate only for physical illnesses.
"I am relieved that Ms. Rea's long fight for coverage for the residential treatment she needed to treat her anorexia nervosa has come to an end.
"The decision is a sweeping affirmation of the broad scope of mental health coverage required by law, a resounding victory for consumers, and affirms the position I have consistently taken with regard to mental health parity as I regulate the health insurance market.
"Although the Rea decision addressed a health care service plan operating under the Knox-Keene Act, a substantially identical Mental Health Parity Act applies to health insurers subject to my jurisdiction. The decision applies equally to insurers and health care service plans."
California Insurance Commissioner Dave Jones
To view opinion document for this case, go to:
- [PDF] http://www.courts.ca.gov/opinions/documents/B244314.PDF
- [DOC] http://www.courts.ca.gov/opinions/documents/B244314.DOC
- Attorney for Marissa Rea: Kantor and Kantor, Lisa S. Kantor 818-886-2525.
- Mental Health Parity Act of 1999
- Judge Johnson wrote in his opinion "We do not find DMHC's actions and positions taken with respect to residential treatment have the significance Blue Shield attributes to them."
- The court rejected the position of the Department of Managed Health Care, which upheld Blue Shield's denial of coverage.
- After a decision issued by the U.S. 9th Circuit Court sided with the plaintiffs, Blue Shield argued that federal decisions would not hold authority over a policy governed by the state. A Los Angeles trial court agreed. The plaintiffs appealed, at which point the Department of Insurance stepped in as an amicus curiae, arguing in support of Rea and Melachouris.
- Link to brief of amicus curiae in support of appellant from Commissioner Jones.
The California Department of Insurance, established in 1868, is the largest consumer protection agency in California. Insurers collect $310 billion in premiums annually in California. Since 2011 the California Department of Insurance received more than 1,000,000 calls from consumers and helped recover over $469 million in claims and premiums. Please visit the Department of Insurance website at www.insurance.ca.gov. Non-media inquiries should be directed to the Consumer Hotline at 800.927.4357. Telecommunications Devices for the Deaf (TDD), please dial 800.482.4833.