U.S. District Judge Faith S. Hochberg of the U.S. District Court for the District of New Jersey decided the case against Aetna would have to move forward under the Employee Retirement Income Security Act (ERISA) rather than New Jersey’s Mental Health Parity Law.Hochberg turned away Aetna’s requests to throw out the case, which the insurer asserted should be decided by state regulators or handled by its internal appeals process.
Francis De Vito and Jeff Meiskin filed the suit containing allegations the insurer improperly denied coverage for treatment for their daughters’ eating disorders after ruling eating disorders were “non-Biologically Based Mental Illnesses (BBMI).” In so doing, plaintiffs alleged Aetna breached its insurance contracts, violated itsfiduciary duties, and denied Plaintiffs benefits to which they were entitled.
According to the opinion, the plaintiffs’ case centers on whether eating disorders are biologically based mental illnesses, which would entitle policyholders to a higher level of coverage than for purely mental conditions.
Although the two plaintiff policies defined BBMI and list examples, Hochberg wrote, “The policies are therefore silent on whether plaintiffs’ eating disorders are or are not BBMIs. This case requires the court to review Aetna’s administrative record as to its basis for assigning eating disorders to the non-BBMI category.”
Hochberg’s ruling is here .
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