SOURCE: Psych-Appeal

Psych-Appeal

September 03, 2015 12:29 ET

Psych-Appeal, Inc. and Zuckerman Spaeder LLP File Class-Action Lawsuit Against Aetna for Allegedly Denying Depression Treatment

Case Among First to Question Bias of Independent Review Organizations

NEW HAVEN, CT--(Marketwired - Sep 3, 2015) -  Psych-Appeal, Inc., in conjunction with Zuckerman Spaeder LLP and LeClairRyan, P.C., has filed a class-action lawsuit against Aetna on behalf of mental health patients suffering from depression. The federal lawsuit alleges that Aetna has categorically refused to cover a safe and effective treatment called Transcranial Magnetic Stimulation (TMS).

"Aetna has unjustifiably categorized TMS as 'experimental and investigational' while Medicare and numerous commercial insurers routinely cover it," said Brian Hufford, partner at Zuckerman Spaeder, LLP. "By denying coverage for TMS, Aetna is preventing patients from receiving potentially lifesaving care."

In 2008, the U.S. Food and Drug Administration cleared TMS for patients who have failed to respond to psychotropic medications. Unlike electroshock therapy, TMS is performed on an outpatient basis without sedation and does not typically result in side effects such as memory loss. 

The complaint also alleges that MCMC, LLC, an independent review organization, directly contracted with Aetna to evaluate external appeals of Aetna's TMS denials, rubber-stamps the insurer by relying on outdated clinical research and misapplying health plan criteria that violate the federal Mental Health Parity and Addiction Equity Act.

"This case will be among the first to highlight the conflicts of interest that independent review organizations have when they are allowed to contract directly with insurers to evaluate claim denials," said Meiram Bendat, mental health attorney and founder of Psych-Appeal, Inc.

The class action has been filed with co-counsel Elizabeth K. Acee and Daniel P. Elliott of Connecticut-based LeClairRyan P.C.

Interested parties may contact Meiram Bendat at mbendat@psych-appeal.com or Brian Hufford at dbhufford@zuckerman.com.

About Psych-Appeal, Inc.
Los Angeles-based Psych-Appeal, Inc. is a law firm exclusively dedicated to mental health insurance claims, advocating on behalf of patients, clinicians and treatment facilities to overcome insurer denials of treatment. For more information, visit www.psych-appeal.com.

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