A second lawsuit has been filed in South Dakota alleging that health insurer Wellmark refused to pay for a patient who underwent treatment for an eating disorder.
The lawsuit says that the woman, who is identified as Bridget S., should have been covered when she went to Insight Behavioral Health Center in Chicago to undergo treatment for a severe case of bulimia nervosa.
At the time she went into treatment in 2016, Bridget S. was about 23 and covered under a Wellmark policy through her parents, the lawsuit says. The policy included treatment for bulimia.
More:Insurer sued after backing out on eating disorder treatment bills it had promised to cover
Bridget S. was admitted into an inpatient treatment program from Sept. 9, 2016 to Oct. 5, 2016 and then received out-patient care until Jan. 6, 2017. Wellmark refused to pay about $19,000 in bills, the lawsuit says.
As part of its denial, Wellmark relied on an opinion from Dr. William Holmes, saying the care was not medically necessary. Holmes also supplied the same opinion in the first lawsuit filed against Wellmark by a woman named Olivia H.S., who sued last year.
“Wellmark SD and/or Wellmark Iowa knew Holmes was biased in favor of providing reports that supported denial or limitation of insurance benefits for eating disorder treatment,” the most recent lawsuit says.
Wellmark has declined to comment on ongoing litigation, as has the attorney for the women in both cases, Mike Abourezk. The company has denied wrongdoing in the first lawsuit.
Last year, the Argus Leader reported that a Minnesota-based treatment facility called The Emily Program stopped accepting patients who were covered by Wellmark because the insurer was pre-authorizing them for treatment but then refusing to pay at the end of treatment.
Both lawsuits claim Wellmark had a pattern of refusing to pay benefits they owed their insureds. The suits contend the insurance company breached its contract and acted in bad faith.
The lawsuit was filed in federal court.
