1. Case Name: Reid v. BCBSM, Inc., United States District Court for the District of Minnesota, November 21, 2013; 984 F. Supp. 2d 949

2. Lawyers:

  • Counsel for Plaintiff: Tracy L. Reid, Plaintiff Pro se
  • Counsel for Defendant:
    • (BCBSM & Blue Cross Blue Shield of Minnesota) Joel A. Mintzer, Robins Kaplan Miller & Ciresi LLP
    • (HealthPartners Insurance Company) Gregory R. Mertz, Ashley M. Bennett Ewald, Gray Plant Motty Mooty & Bennett, PA
    • (Minnesota Department of Commerce) Oliver J. Larson, John R. Mule, Minnesota Attorney General’s Office

3. Format: Published Memorandum Opinion and Order

4. Outline: Plaintiff brought this individual action on behalf of herself and her seven-year-old son (M.A.R.) who is diagnosed with autism spectrum disorder. M.A.R. was referred for intensive behavioral therapy, which greatly benefited him and he displayed improved behavior and allowed him to be integrated with his peers at school. However, Plaintiff’s insurance plan, HealthPartners, specifically excluded intensive behavioral therapy for the treatment of autism. Plaintiff appealed but the denial was upheld. Plaintiff changed insurance plans in January 2012 – she was self-insured and contracted with Blue Cross. Blue Cross denied her claim for intensive behavioral therapy based stating it was not medically necessary. Plaintiff appealed the decision successfully, however in November 2012, Blue Cross informed Plaintiff that it was changing the policy to exclude coverage of intensive behavioral therapy. Plaintiff then brought this suit. Plaintiff alleges seven claims: 1) violation of Minnesota’s Mental Health Parity Act, 2) violation of Minnesota’s Human Rights Act, 3) violation of the ADA, 4) violation of Minnesota’s Deceptive Trade Practices Act, 5) violations of Minnesota’s Consumer Fraud Act, 6) violation of the ACA, and 7) violation of ERISA. She seeks declaratory and injunctive relief. Defendants move to dismiss.

5. Legal Pointer: Plaintiff’s autistic son was denied access to intensive behavioral therapy by two separate plans. The first plan, HealthPartners, specifically excluded this type of therapy for the treatment of autism. The second plan, Blue Cross, first denied the therapy as not medically necessary and then changed the plan to exclude coverage of the therapy based on industry practices. Plaintiff brought suit against both plans, although she several of the counts argued are applied only against Blue Cross (counts IV, V and VI).

6. Legal Issues and Causes of Action: Plaintiff claims that the actions of both health plans violated Minnesota’s Mental Health Parity Act, Minnesota’s Human Rights Act, the ADA, and ERISA. She also argues that the actions of Blue Cross violated Minnesota’s Deceptive Trade Practices Act, Minnesota’s Consumer Fraud Act, and the ACA. Both Defendants bring a motion to dismiss.

  • Ruling: HealthPartner’s Motion to Dismiss is granted; Blue Cross’ Motion to Dismiss is granted as to counts I, IV, V, VI and VII; Blue Cross’ Motion to Dismiss is denied as to counts II and III.

7. Narrative Case Description: Plaintiff brought suit challenging both insurer’s decisions to deny her son’s claim for intensive behavioral therapy to treat autism. Plaintiff alleges seven claims.

Before the Court considered Plaintiff’s claims, they considered her standing to bring suit. In regards to Defendant HealthPartners, Plaintiff was found to not have standing because the relief sought would not redress her injury. Plaintiff sought declaratory and injunctive relief but not damages for her past injury. When she changed her insurance policy from Defendant HealthPartners to Defendant Blue Cross, the alleged injury in regards to HealthPartners was in the past. Therefore, the relief she sought would not redress past injury, only future injury and there was no threat of ongoing harm.

Plaintiff’s claim against BlueCross for violations of the ADA was found to have merit and could proceed. Plaintiff argued that the exclusion of behavioral therapy is a disability-based distinction. Defendant argued that the exclusion did not violate the ADA because it applies equally to all persons. The Court did not find the Defendant’s argument persuasive because the exclusion only applies to disabled persons and only applies to the treatment of one condition, autism.

Similarly, Plaintiff’s claim for violations of the Minnesota Human Rights Act was found to have merit to move forward. The MHRA is similar to the ADA and claims are analyzed in the same manner.

Plaintiff’s claims relating to ERISA were dismissed. Plaintiff did not seek to recover past benefits but rather declaratory and injunctive relief. The Court found that this was outside the scope of ERISA, as “she is not seeking to recover benefits due under the terms of the plan, she is seeking to change the terms of the plan, which ERISA does not permit.”

Plaintiff’s consumer protection claims were also dismissed. Again, because the relief sought is not the recovery of benefits but rather injunctive relief, the Plaintiff must prove that there is a threat of future or irreparable harm. In this case, the Plaintiff did not claim future or irreparable harm and therefore, the claims are dismissed.

Finally, Plaintiff’s claims under ACA and the Minnesota Mental Health Parity Act are dismissed. Plaintiff did not defend these claims in her brief and had not located any authority to support these claims.

8. Additional Comments: None

9. Website: https://www.gpo.gov/fdsys/granule/USCOURTS-mnd-0_12-cv-03005/USCOURTS-mnd-0_12-cv-03005-0

10. Practical Implications and Lessons Learned: Many of Plaintiff’s claims were denied based on the relief sought. It may behoove plaintiffs to consider different types of damages in order to preserve claims. Additionally, the Defendant’s specific exclusion is again found to be potentially improper.

11. All Legal Theories Presented in Case: Violations of ERISA, ACA, ADA, Minnesota Mental Health Parity, Minnesota Human Rights Act, Minnesota Deceptive Trade Practices Act, Minnesota Consumer Fraud Act

12. Successful Legal Theories in Case: ADA, Minnesota Human Rights Act

 

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