In Perrone v. Blue Cross Blue Shield of Mich., 2025 WL 2027540 (W.D. Mich. 2025), a group health plan participant sued Blue Cross Blue Shield (BCBS) when it denied his claim for a stay at an out-of-network mental health treatment facility. The participant alleged that he had received confirmation by phone that his stay would be covered. In his suit, he sought recovery of benefits under the Employee Retirement Income Security Act (ERISA), equitable relief under the Mental Health Parity and Addiction Equity Act (MHPAEA), and breach of insurance contract.
In response, BCBS claimed that ERISA preempted the breach of contract claim and that MHPAEA provides no private right of action. As a result, BCBS asked the court to dismiss those claims.
The court ultimately dismissed the breach of contract claim, finding that ERISA preempted the claim as directly related to the benefit plan. The court further found that the claim was duplicative of the claim to recover benefits under ERISA. However, the court refused to dismiss the MHPAEA claim; although the MHPAEA creates no private right of action, ERISA allows plan beneficiaries to enforce MHPAEA provisions through its private right of action.
Therefore, group health plans subject to ERISA must be aware that plan participants can pursue and enforce MHPAEA violations because of MHPAEA's incorporation into Title I of ERISA. Plan participants or their beneficiaries can sue under ERISA §502(a)(1)(B) to recover benefits under ERISA, and under ERISA §501(a)(3) to stop actions that violate plan terms or ERISA provisions, including the MHPAEA requirements.
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