Ultra Health, patients sue insurers over cannabis coverage

Copyright © 2022 Albuquerque Journal

New Mexico Top Organics-Ultra Health and six medical patients filed a class action lawsuit, arguing that insurers should bear the cost of medical cannabis because it is a behavioral health service.

The lawsuit was filed Friday in Albuquerque State District Court against seven state insurers – Blue Cross and Blue Shield of New Mexico, True Health New Mexico, Cigna Health and Life Insurance Co., Molina New Mexico Healthcare, Presbyterian Health Plan, Presbyterian Insurance Co. and Western Sky Community Care – for not covering medical cannabis costs.

The plaintiffs in the lawsuit seek “to recover themselves, and for any other behavioral or mentally ill patient in a similar situation unlawfully subjected to payment of the full cost of medically necessary cannabis, in violation of the law of the United States.” ‘State “.

“The idea of ​​health insurance plans paying for medical cannabis may seem like an impossible dream, but all the fundamentals are already in place,” Ultra Health President and CEO Duke Rodriguez said Monday. , in a press release. “The behavioral healthcare revolution in New Mexico will only take small steps, rather than one giant leap.”

True Health New Mexico and Blue Cross and Blue Shield of New Mexico declined to comment. Molina Healthcare of New Mexico, Western Sky Community Care and Cigna did not immediately respond to requests for comment.

Presbyterian Health Plan and Presbyterian Insurance Co. — which fall under the same management structure — also declined to comment.

“The Presbyterian Health Plan is committed to ensuring New Mexicans can access the behavioral health services they need,” spokeswoman Melanie Mozes said. “We have not yet been notified of the lawsuit and will reserve comment for the appropriate venue.”

The heart of the lawsuit, according to Rodriguez, stems from legislation passed in 2021. Senate Bill 317, signed by Governor Michelle Lujan Grisham in April 2021, focuses on behavioral health cost sharing. The law – which took effect on January 1 – states that insurers must cover 100% of behavioral health services, including prescribed treatment of a behavioral health problem.

More than 73,000 medical patients of the 134,307 patients enrolled in the medical cannabis program in the state have PTSD, according to April data from the New Mexico Department of Health.

In February, Ultra Health sent a letter to New Mexico health insurers and the Office of the Superintendent of Insurance asking for assurance that cannabis coverage is a behavioral health service under the law. But Ultra Health said the state and insurers have yet to respond to that letter.

Rodriguez said the trial opens doors for more medical patients.

“There will be more identified patients who have been harmed by insurers who do not meet the legal obligation to eliminate any cost sharing related to behavioral health services,” Rodriguez said. “The insurers did not act in good faith.”

The six medical patients listed as plaintiffs, notably, include State Senator Jacob Candelaria.

Candelaria, according to the lawsuit, has been a medical patient since 2019 at the request of his doctor who recommended that he use cannabis to help treat his post-traumatic stress disorder after having little success with antidepressants.

According to the lawsuit, he spends between $500 and $1,000 a month on medical cannabis and has paid entirely out of pocket since becoming a medical patient. He is insured with Blue Cross and Blue Shield of New Mexico, according to the lawsuit.

In an interview with the Journal on Monday, Candelaria described her experience with medical cannabis in the treatment of her PTSD, saying it had a positive effect on her life. He said he signed the lawsuit not for his own benefit, but for the many “new Mexicans struggling to pay for health care.”

“Senate Bill 317 was transformational,” Candelaria said. “This suit, you know, it becomes necessary to make that transformation happen.”

The other plaintiffs are Tomas Lorenzo Valencia, Bryce Bryant-Flynn, Matias Trujillo, Erica Rowland and Ariel McDougal – all of whom are medical patients.

Medical cannabis became legal in New Mexico under the government of the day. Bill Richardson, who signed the law known as the Lynn and Erin Compassionate Use Act, in 2007.