The daughter was born with congenital heart defects, which required multiple open-heart surgeries, according to the report. Complications from the surgeries led to extended hospital stays that included induced comas and required ventilator support.
Her medical issues led to struggles throughout her adolescence, according to the report. She was admitted to a residential treatment facility where she was treated for mental, emotional and behavioral issues; developmental disturbances; and environmental adjustment problems. Specialists at the facility said she needed 24/7 supervision to develop necessary skills and functional behavior.
The father submitted claims for her treatment under his insurance plan with Anthem Blue Cross, but the payer denied the claim as not medically necessary and said the daughter did not require 24-hour care, according to the report.
The father alleges Anthem violated the Employee Retirement Income Security Act and the Mental Health Parity and Addiction Equity Act, according to the report. The denial caused the father to incur more than $50,000 in medical expenses he said should have been covered by the plan, according to the lawsuit.