Harvard Pilgrim Must Reevaluate Teen's Mental Health Care Claim – Bloomberg Law

By Jacklyn Wille
A Massachusetts teenager with mental health issues and anorexia won a federal court order requiring Harvard Pilgrim Health Care Inc. to rethink its decision denying coverage for her five-week stay at an out-of-network residential treatment center.
The doctors Harvard Pilgrim assigned to review the teenager’s file disregarded the opinions of her treating physicians without any meaningful explanation, the US District Court for the District of Massachusetts held Monday. Although the teenager’s doctors “repeatedly emphasized” her need for mental health treatments, the file reviewers failed to adequately address her “multifaceted diagnoses,” the court said.
The teenager—referred to as K.D.—spent over a …
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