Corona, CA asked in Health Care Law for California

Q: Can a religious organization health plan gran non-covered services to one employee's dependent while denying it to other

The employer offers a uniform healthcare plan to all employees with a wellness benefit. When I joined the company I was told in no uncertain terms that the Plan Document Excludes any treatment for Developmental Disabilities including Autism. My wife spoke with customer services and a supervisor of the plan asking if speech or OT or ABA would be covered. She was directed to use Medi-Cal for ABA and any other therapy associated with my dependents' autism and told not to waste time with denials. Months later, I find out another employee who has been there forever,is getting full coverage for his autistic daughter for ABA, Speech, OT and any other therapy to treat her autism. The health plan has not changed nor the plan document. Other families with autistic children are getting denials for services and are being told to utilize Medi-Cal as well like my family. Is it OK or legal for this religious organization to offer services to one employee's autistic child and not to any others?

Related Topics:
1 Lawyer Answer
Maurice Mandel II
Maurice Mandel II
  • Newport Beach, CA
  • Licensed in California

A: Ok, so this is a health plan provided by a religious organization acting in the capacity of an employer. While religious organizations are granted a lot of leeway in choosing benefits within the scope of the practices of the faith, they are still prohibited from other types of discrimination. What you describe could be a violation of ERISA because the employer provided health plan is an employee benefit possibly covered by ERISA. You need to consult with an ERISA attorney or an attorney that practices in the area of insurance benefits/ health plans/ wrongful denial of benefits. It does not sound correct that some employees get the benefits and others do not unless there are possibly Executive plans. An attorney needs a full examination of all facts to give an opinion.

Justia disclaimers below, incorporated herein.

Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.

The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.

Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.