As someone who used to write appeals against denials issued by Horizon BCBS of NJ and represent K&K clients at Insurance Commission Hearings with Horizon BCBS of NJ, I was especially thrilled to read this Opinion. heres one good quote from the Opinion...full Opinion below: Horizon argues that Plaintiff does not mean Criterion A because she was completing her meal plan, not purging and even self portioning out food. In contrast, Plaintiff argues that she satisfied the severity prong under Criterion A because all of her therapist ans physicians agreed that attempting to plan therapeutic re-entry into the community at the time benefits were denied would exacerbate her eating disorder and quickly cause [Mirsky] to spiral out of control to the point where readmission and continued residential care would be necessary. Contrary to Horizons assertion that Plaintiffs progress demonstrated that inpatient care was no longer medically necessary, all of Plaintiffs therapists and physicians unanimously agreed that she was not mentally fit to return to the community as an outpatient. THANK YOU, Judge Dennis M. Cavanaugh. Thank you so much. Link to full Opinion: cases.justia/federal/district-courts/new-jersey/njdce/2:2011cv02038/256983/20/0.pdf?ts=1411592999
Posted on: Fri, 31 Oct 2014 18:02:45 +0000
Trending Topics
Recently Viewed Topics
© 2015