A federal judge rejected Blue Cross Blue Shield of Rhode Island’s motion to dismiss a lawsuit over coverage of wilderness therapy, according to Oct. 14 court documents.
Wilderness therapy is a mental health intervention that involves immersing young people in outdoor settings. These programs have often been questioned for their ethics.
A plan member sought reimbursement for a beneficiary’s stay with the now-shuttered Aspiro Wilderness Adventure Therapy. BCBS of Rhode Island denied the claims, totalling $49,725. The member appealed the decision as they believed the plan did not exclude that kind of treatment.
The member argued that Aspiro offered “intermediate care services,” which are covered by the plan, while BCBS of Rhode Island said wilderness therapy was not explicitly outlined as one of these services. The court found ambiguity in the policy.
“Because Aspiro may be an intermediate care service within the meaning of the plan, the court finds that the plaintiffs have plausibly claimed it to have been a covered healthcare service,” said U.S. District Court Judge Mary McElroy.
Wilderness therapy has long been a contentious issue for health insurers. Harvard Pilgrim Health Care, Blue Cross Blue Shield of Massachusetts and Aetna have faced similar lawsuits.
