Who is a Class Member
Class members of the Blue Shield of California Mental Health Coverage Settlement include “all participants or beneficiaries of a health benefit plan administered by either Blue Shield defendant and governed by ERISA whose request for coverage (whether pre-authorization, concurrent, post-service, or retrospective) was denied, in whole or in part, between August 1, 2019 and the present, based upon the Magellan Medical Necessity Criteria Guidelines for any of the following levels of care:
- Residential Treatment, Psychiatric
- Residential Treatment, Substance Use Disorders, Rehabilitation
- Intensive Outpatient Treatment, Psychiatric
- Intensive Outpatient Treatment, Substance Use Disorders, Rehabilitation”
Note: The Settlement does not apply to people who sought coverage for treatment for eating disorders or treatment for sexual disorders.
If you don’t qualify for this settlement, check out our database of other class action settlementsyou may be eligible for.
- Reimbursement for Treatments
The settlement provides for the following payments to Class members:
- Each Class member with a Treatment Amount will receive a full reimbursement, unless the amount exceeds 75% of the Settlement Fund. In the event that this happens, the settlement will be dispersed on a pro rata (equal) basis.
The Plan of Allocation discusses in greater detail how your payout will be calculated.
Proof of Purchase
- There is no Claim Form or Deadline. If you are included in the Class and do not exercise your right to opt out, you will automatically receive a payout.
Blue Shield of California Mental Health Coverage Settlement Notes
- Des Roches, et al. v. California Physicians’ Service, et al.
- Case No. 5:16-cv-2848 (LHK)
- Pending in the U.S. District Court for the Northern District of California
This class action lawsuit challenges California Physicians’ Service d/b/a Blue Shield of California alleged illegal practice of applying excessive restrictions on medical necessity criteria guidelines (Challenged Guidelines), resulting in wrongful denials of claims for coverage of mental heath treatment that otherwise may have been approved.
Specifically, the plaintiffs allege that Blue Shield of California developed, adopted, and applied guidelines for coverage of treatment for psychiatric and substance use disorders at the residential and intensive outpatient levels of care that are more restrictive than generally accepted professional standards.
Blue Shield of California denies any wrongdoing and says they have fully complied with the law.Complete details are provided in the Settlement Agreement. The Settlement Agreement and other related documents are available on the Blue Shield of California Mental Health Coverage Settlement website.
Class members who wish to opt out or object to the terms of the Blue Shield of California Mental Health Coverage Settlement must do so by August 5, 2019. Class members who wish to participate in the settlement do not need to do anything to receive a payout.
- 6/5/18: Objection or Exclusion Deadline
- 6/28/18: Final Hearing at 1:30 pm PT* (class members do not need to attend this hearing in order to receive a slice of the settlement pie).
*Settlement Class Members who wish to speak at the hearing should check ChallengedGuidelinesSettlement.com to confirm that the date or time of the Hearing has not been changed.
- Mail: Challenged Guidelines Settlement, PO Box 30352, Philadelphia, PA 19103
- Phone: 1-888-573-6825
- Email: ChallengedGuidelinesSettlement@AdministratorClassAction.com