Florida Blues & New Directions Sued Over Restrictive Guidelines For Residential Treatment

On September 5, 2019, attorneys with Psych-Appeal and Zuckerman Spaeder filed a lawsuit alleging that New Directions Behavioral Health, LLC and Blue Cross Blue Shield of Florida, Inc. (BCBSF) used improper medical necessity criteria to deny access to covered benefits for residential treatment for a commercially covered member with a severe eating disorder. New Directions Behavioral Health is BCBSF’s behavioral health claims administrator for the plaintiffs’ employer-sponsored health plan. The plaintiff alleged the denials violated the Employee Retirement Income Security Act of 1974 (ERISA). Because New Directions denied treatment, the plaintiff paid for the services out-of . . .