United States District Court, D. Utah, Central Division
MEMORANDUM DECISION & ORDER
Benson United States District Judge
matter is before the Court on Defendant Anthem Blue
Cross's Motion for Judgment on the Pleadings and Partial
Summary Judgment on Plaintiffs' Second Cause of Action
(Dkt. 32), and Plaintiffs' Motion for Leave to File
Amended Complaint (Dkt. 22). The motions have been fully
briefed. The Court concludes that a hearing would not
significantly aid its determination of the motions.
Accordingly, the Court issues the following Memorandum
Decision and Order based on the written submissions of the
parties and the law and facts relevant to the pending
motions. DUCivR 7-1(f).
an ERISA case. J.L. and C.L. are the parents of A.L.
(collectively “Plaintiffs”), all of whom are
beneficiaries of a group health plan that is sponsored and
funded by Defendant Northrup Grumman. (Dkt. 2, Compl.
¶¶ 1-2.) Defendant Anthem Blue Cross is the
third-party claims administrator for the Plan. (Id.
a minor with a long history of mental health issues including
but not limited to anxiety and depression. On May 13, 2016,
A.L. was admitted to Sunrise, a residential treatment center
for adolescent girls, located in Utah. A.L. was discharged
from Sunrise on August 7, 2017. (Id. ¶¶
first 50 days at Sunrise (May 13, 2016 through July 1, 2016)
were covered by the Plan, based on Defendant's decision
that the first 50 days were medically necessary.
(Id. ¶ 33; Dkt. 31-1 Exh. C, May 20, 2016
Letter from Anthem (stating that A.L's initial10-day stay
at Sunrise (from 05/13/16-05/23/16) was certified as
“medically necessary”); Dkt. 31-1 Exh. D, Sept.
14, 2017 Letter from Anthem (approving 40 days of treatment
at Sunrise stating: “It was determined that services
from 5/23/16-07/01/16 were medically necessary”).)
However, Defendant concluded that no benefits should be paid
for A.L.'s stay at Sunrise after July 1, 2016, because
Defendant determined it was not medically necessary under the
terms of the Plan and applicable residential treatment center
criteria. (Dkt. 2, Compl., ¶ 39; Dkt. 31-1 Exh. D.)
appealed the denial of coverage and exhausted the
administrative appeals process. (Id. ¶ 42.)
August 28, 2018, Plaintiffs filed the Complaint in this case,
seeking to recover benefits for A.L.'s stay at Sunrise
from July 2, 2016 through August 7, 2017. Plaintiffs'
Complaint sets forth two causes of action: (1) a claim for
benefits pursuant to ERISA under 29 U.S.C. 1132(a)(1)(B); and
(2) a claim alleging violation of the Mental Health Parity
and Addiction Equity Act of 2008 (MHPAEA) under 29 U.S.C.
parties have motions pending before the Court. Defendant
seeks summary judgment on Plaintiffs' Second Cause of
Action - the MHPAEA claim. (Dkt. 32.) Plaintiffs seek leave
to file an Amended Complaint. (Dkt. 22.)
Defendant's Motion for Summary Judgment on
Plaintiffs' Second Cause of Action Alleging Violation of
the Mental Health Parity and Addiction Equality
asks this Court to grant summary judgment on Plaintiffs'
Second Cause of Action which is based on the Mental Health
Parity and Addiction Equality Act. The MHPAEA
“prohibits the imposition of more stringent treatment
limitations for mental health treatment than for medical
treatment.” Bushnell v. UnitedHealth Group,
Inc., 2018 WL 1578167, *4 (S.D.N.Y. Mar. 27, 2018). The
Act requires that if a health plan provides “both
medical and surgical benefits and mental health or substance
abuse disorder benefits, ” then the plan must ensure
that (1) “the treatment limitations applicable to such
mental health or substance use disorder benefits are no more
restrictive than the predominant treatment limitations
applied to substantially all medical and surgical benefits
covered by the plan (or coverage)”; and (2)
“there are no separate treatment limitations that are
applicable only with respect to mental health or substance
use disorder benefits.” 29 U.S.C. §
limitations under the MHPAEA can be quantitative or
nonquantitative. 29 C.F.R. § 2590.7212(a). Quantitative
limitations include, for example, a limitation on the number
of outpatient visits that an insurance plan will cover.
Id. Nonquantitative limitations include
“restrictions based on geographic locations, facility
type, provider specialty, and other criteria that limit the