As discussed here and here, D.K. et al. v. United Behavioral Health et al. is a case that has been carefully watched in the health benefits space for its impact on what health plan administrators must include in adverse benefit determination letters. In D.K., the Tenth Circuit held health plan administrators cannot rely
As discussed here, D.K. et al. v. United Behavioral Health et al. is a case that has been carefully watched in the health benefits space for its potential to change what health plan administrators must include in adverse benefit determination letters. On May 15, 2023, the Tenth Circuit issued its opinion affirming the district
As discussed here, administrators’ health plan benefit denial letters have recently been under scrutiny by the courts. For example, in D.K. et al. v. United Behavioral Health et al., the Tenth Circuit is reviewing a district court’s decision that health plan benefit denial letters must contain more fulsome discussions of the administrator’s determination
In recent years, several lawsuits have challenged wilderness therapy program exclusions in health plans. Not only do members typically assert a claim for benefits, alleging a denial of wilderness therapy benefits was improper under their health plan, but they also insist the plan’s exclusion that serves as the basis for the denial violates the Mental
Under ERISA claims procedure regulations, group health plans must provide a “full and fair” review of all claims submitted by plan participants. These claims procedure regulations provide a list of minimum standards, including determinations within a certain timeframe, specific content requirements of adverse notifications, and the opportunity to submit evidence through an internal administrative appeal