Wednesday, May 10, 2006
PlanSponsor.com reporterd this ADA health plan discrimination case this morning in its NewsDash E-Newsletter:
The 11th US Circuit Court of Appeals has determined that a health plan administrator did not discriminate against a participant based on her disability when it amended its plan limitations to include the type of physical therapy she received.
Sonia Chaudhry, a dependent on her mother's health benefit plan administered by Neighborhood Health Partnership, Inc., suffered from a lung disease which required daily therapy to prevent mucus buildup in her lungs. The health plan limited coverage of physical, occupational, and speech therapy to 60 visits.
The HMO interpreted this to include Chaudhry's chest physiotherapy, and advised her that her benefits were exhausted after 60 visits. After a Florida agency determined that the physiotherapy was not included in the benefits limit, Neighborhood again began covering Chaudhrys therapy.
However, it amended its plan the following year to include the chest physiotherapy in the services that were limited to 60 visits - and again stopped covering Chaudhry's therapy.
The reason why the amendment to the plan was not considered discriminatory was because the "plaintiff [was] not treated differently than any other beneficiary who may need the same type of therapy."
This outcome appears consistent with similar health care discrimination cases which have been brought pursuant to Section 510 of ERISA, including McGann v. H & H Music Co., 946 F.2d 401 (5th Cir. 1991).
The Eleventh Circuit case of Chaudhry v. Neighborhood Health Partnership, Inc., No. 05-13146 (11th Cir. Apr. 26, 2006), can be accessed here.