Insurer’s Position ‘Impossible To Defend,’ Under Plan, Judge Says

Mealey's (November 5, 2020, 2:00 PM EST) -- SALT LAKE CITY — A health insurer’s denial of coverage based on the lack of precertification for the residential treatment services ignores plan language permitting only a $300 reduction in benefits where the claim is coverable but lacks precertification, a federal judge in Utah said Oct. 30 in remanding Employee Retirement Income Security Act claims for a full and fair review (James C., et al. v. Aetna Health and Life Insurance Co., et al., No. 18-717, D. Utah, 2020 U.S. Dist. LEXIS 203053)....