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Anne M. v. United Behavioral Health

United States District Court, D. Utah

May 6, 2019

ANNE M., DAVID W., and E.W-M., Plaintiffs,
v.
UNITED BEHAVIORAL HEALTH, and the MOTION PICTURE INDUSTRY HEALTH PLAN FOR ACTIVE PARTICIPANTS, Defendants.

          MEMORANDUM DECISION AND ORDER GRANTING IN PART AND DENYING IN PART DEFENDANTS' MOTION TO DISMISS

          TED STEWART, DISTRICT JUDGE

         This matter is before the Court on Defendants' Motion to Dismiss. Defendants seek dismissal of Plaintiffs' second cause of action under the Mental Health Parity and Addiction Equality Act (the “Parity Act”) and dismissal of Anne and David's individual claims. For the reasons discussed below, the Court will grant the Motion in part and deny it in part.

         I. BACKGROUND

         The following facts are taken from Plaintiffs' Complaint and are viewed in the light most favorable to Plaintiffs as the non-moving party.

         Anne M. (“Anne”) and David W. (“David”) are the parents of E.W-M. (“E”). Anne was a participant in the Motion Picture Industry Health Plan for Active Participants (“the Plan”) and E was a beneficiary of the Plan. The Plan is a self-funded employee welfare benefits plan under the Employee Retirement Income Security Act of 1974 (“ERISA”).

         E suffers from various mental health and behavioral issues. Eventually, E was admitted to Uinta Academy (“Uinta”), a residential treatment facility located in Utah. Uinta provides sub- acute treatment to adolescent girls who have experienced trauma and have mental health, behavioral, or substance abuse problems. E stayed at Uinta from November 14, 2014, through October 6, 2016.

         Anne and David submitted a claim to United Behavioral Health (“UBH”) for E's treatment at Uinta. UBH denied Plaintiffs' claim initially and again on appeal. Plaintiffs allege that Anne and David incurred medical expenses totaling over $170, 000 that should have been paid by the Plan. Plaintiffs bring suit under ERISA to recover benefits under the Plan. Additionally, Plaintiffs bring suit under the Parity Act.

         II. MOTION TO DISMISS STANDARD

         In considering a motion to dismiss for failure to state a claim upon which relief can be granted under Rule 12(b)(6), all well-pleaded factual allegations, as distinguished from conclusory allegations, are accepted as true and viewed in the light most favorable to Plaintiffs as the nonmoving party.[1] Plaintiffs must provide “enough facts to state a claim to relief that is plausible on its face, ”[2] which requires “more than an unadorned, the-defendant-unlawfully-harmed-me accusation.”[3] “A pleading that offers ‘labels and conclusions' or ‘a formulaic recitation of the elements of a cause of action will not do.' Nor does a complaint suffice if it tenders ‘naked assertion[s]' devoid of ‘further factual enhancement.'”[4]

         “The court's function on a Rule 12(b)(6) motion is not to weigh potential evidence that the parties might present at trial, but to assess whether the plaintiff's complaint alone is legally sufficient to state a claim for which relief may be granted.”[5] As the Court in Iqbal stated,

[o]nly a complaint that states a plausible claim for relief survives a motion to dismiss. Determining whether a complaint states a plausible claim for relief will . . . be a context-specific task that requires the reviewing court to draw on its judicial experience and common sense. But where the well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct, the complaint has alleged-but it has not shown-that the pleader is entitled to relief.[6]

         In considering a motion to dismiss, a district court not only considers the complaint, “but also the attached exhibits, ”[7] the “documents incorporated into the complaint by reference, and matters of which a court may take judicial notice.”[8] The Court “may consider documents referred to in the complaint if the documents are central to the plaintiff's claim and the parties do not dispute the documents' authenticity.”[9]

         III. DISCUSSION

         A. PARITY ACT

         “Congress enacted the [Parity Act] to end discrimination in the provision of insurance coverage for mental health and substance use disorders as compared to coverage for medical and surgical conditions in employer-sponsored group health plans.”[10] The Act requires that a plan's treatment and financial limitations on mental health or substance abuse disorder benefits be no more restrictive than the limitations for medical and surgical benefits.[11]

         The Parity Act's implementing regulations state:

A group health plan (or health insurance coverage) may not impose a nonquantitative treatment limitation with respect to mental health or substance use disorder benefits in any classification unless, under the terms of the plan (or health insurance coverage) as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the nonquantitative treatment limitation to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, ...

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