A recent legal development delineates the case of a former employee of DLA Piper LLP in the US who obtained a court mandate compelling Anthem Blue Cross Life & Health Insurance Co. to reevaluate its denial to cover a $33,000 medical bill. The bill in question was for a two-month wilderness therapy program in Utah, which the employee’s daughter attended.
The insurance provider declined coverage for the program, citing that it was experimental or investigational. However, it was deemed by Judge Dale A. Kimball that Anthem did not substantively address the evidence provided by the complainant contradicting this characterization. It’s interesting to note that Anthem’s medical policy describes investigational procedures as primarily limited to laboratory or animal research.
The case resurfaced concerns about insurance providers’ assessment of novel treatments’ effectiveness, especially when they have some traditional elements. The unique treatment program that sparked this lawsuit combines conventional treatments with nature-based experiences, such as hiking and camping.
Additional details on Judge Kimball’s decision can be found in the official court document located here. However, the verdict fundamentally requires the insurance company to reevaluate the claim, taking into account the evidence of the wilderness program’s effectiveness initially presented by the claimant.
More information about the case is available via the original article on Bloomberg Law.