Filed in the United States District Court for the Western District of Michigan, the complaint alleges that the state’s largest health insurer has been underpaying and wrongfully denying claims related to treatment for substance abuse and other behavioral health disorders.
Napoli Shkolnik PLLC filed a lawsuit in the United States District Court for the Western District of Michigan on behalf of four substance abuse treatment centers (Serenity Point Recovery, A Forever Recovery, Behavioral Rehabilitation Services, Best Drug Rehabilitation) against Blue Cross Blue Shield of Michigan (BSBSMI) based upon their failure to properly pay benefits related to substance abuse treatment and other behavioral health disorders for over 4,000 patients.
The complaint seeks compensatory damages exceeding $40 million dollars, punitive damages, disgorgement of profits, declaratory and injunctive relief, and attorneys’ fees and costs and other relief.
For years, Michigan’s largest health insurer has placed profits over the lives of its members.
In 2018, the CEO of BSBSMI, a “non-profit” corporation, was paid $20 million dollars while the company reported profits of over $580 million dollars on $29.3 billion dollars in revenue.
Meanwhile, since June 2016, it has unjustifiably slashed benefits and denied claims related to substance abuse and other behavioral health issues. In most cases, the rates paid by BCBSMI for these services are below the actual cost to providers of offering services – and even below the rates paid by Medicaid.
This has resulted in the closing of treatment centers and surprise medical bills to patients and families who rightfully believed that treatment would be covered.
The overall effect has been the denial of access to lifesaving services at a time when they are most desperately needed.
Michigan is one of the states hardest hit by the opioid epidemic, with an average of 7 Michiganders dying each day from overdose.
Deaths from overdose in Michigan annually exceed the rate of deaths by car accident and firearms in the state, combined.
BCBSMI’s actions are in violation of the terms of their insurance plans with members, ERISA, the Federal Mental Health Parity and Addiction Equity Act (Parity Act), as well as state laws prohibiting fraud, unfair business practices and other illegal acts.
The case is the Serenity Point Recovery, Inc, et al. v. Blue Cross Blue Shield of Michigan, case number 19-cv-00620, in the United States District Court for the Western District of Michigan.
If you are a substance abuse treatment center or behavioral health facility and believe that Blue Cross Blue Shield of Michigan, or any other commercial insurance company, has been underpaying or wrongfully denying claims, we encourage you to please call us at today.
Napoli Shkolnik PLLC offers a free legal analysis based on your specific circumstances.
There are no upfront legal fees and we only recover a fee when we win your case.
Partner Matt Lavin has experience representing healthcare provider clients against big insurance companies.
Mr. Lavin also worked for many years at a substance abuse treatment center and therefore truly understands the needs of his clients.
We strongly encourage you to contact Matt and his team for a free, no-obligation consultation to review your legal options.