Stephanie C. v. Blue Cross Blue Shield of Massachusetts HMO Blue, Inc., No. 16-1997 (1st Cir. 2017)Annotate this Case
Plaintiff brought this case pursuant to the Employee Retirement Income Security Act (ERISA), seeking reimbursement for certain expenses connected with the treatment of her teenage son. The plan administrator, Blue Cross Blue Shield of Massachusetts HMO Blue, Inc. (BCBS) denied the portions of Plaintiff’s claim that were in dispute in this case. The district court upheld BCBS’s action. The First Circuit affirmed, holding that, applying the plain language of the ERISA plan, the clear weight of the evidence dictated a finding that the disputed charges were not medically necessary, as defined in the plan, and therefore were not covered.