Health Plan Amendment Does not Violate ADA

May 9, 2006 ( - The 11th US Circuit Court of Appeals has determined that a health plan administrator did not discriminate against a participant based on her disability when it amended its plan limitations to include the type of physical therapy she received.

According to the appellate court, the limits of the plan and its amendment apply to all beneficiaries regardless of what ailment they suffer or whether or not they are disabled.   The plaintiff is not treated differently than any other beneficiary who may need the same type of therapy, the court said, so the amended plan does not violate the Americans with Disabilities Act (ADA).

Sonia Chaudhry, a dependent on her mother’s health benefit plan administered by Neighborhood Health Partnership, Inc., suffered from a lung disease which required daily therapy to prevent mucus build up in her lungs.   The health plan limited coverage of physical, occupational, and speech therapy to 60 visits.

The HMO interpreted this to include Chaudhry’s chest physiotherapy, and advised her that her benefits were exhausted after 60 visits.   After a Florida agency determined that the physiotherapy was not included in the benefits limit, Neighborhood again began covering Chaudhry’s therapy.

However, it amended its plan the following year to include the chest physiotherapy in the services that were limited to 60 visits.   After it again stopped covering Chaudhry’s therapy under the amended plan provisions, she filed a lawsuit claiming the amended plan discriminated against her based on her disability under the ADA by singling out her specific therapy and because she was the only plan beneficiary requiring such treatments.

The appellate court determined that Chaudhry cited no authority that Neighborhood’s denial of a particular type of treatment or limitation on treatments discriminated against her.

The opinion is here .