American Journal of Law & Medicine

Health insurance: review agents may not make delayed coverage decisions under Vermont insurance law.(Select Recent Court Decisions)

Health Insurance: Review Agents May Not Make Delayed Coverage Decisions Under Vermont Insurance Law--Merit Behavioral Care Corporation and Magellan HRSC, Inc. v. State of Vermont Independent Panel of Mental Health Providers, Austen Riggs Center and Jane Doe (1)--The Supreme Court of Vermont held that "[section] 4089a(c)(5) [of the state insurance code] obligates 'review agents' to conduct their mental health coverage reviews in accordance with the prospective/concurrent requirement, regardless of whether the legislature anticipated regulations elaborating on such requirements." (2) Merit Behavioral Care Corporation ("Merit") has a contract with the State of Vermont to manage the mental healthcare of state employees who are under the State's medical benefit plan. Merit contracted Austen Riggs, a private healthcare facility, to serve as one of its mental healthcare providers. Jane Doe, a state employee, was referred to Austen Riggs for treatment of a long-term mental disorder. Austen Riggs' policy required appropriate candidates to be admitted to the hospital for a minimum of thirty days. …

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