Ultra Health, patients are suing insurers for cannabis coverage

Copyright © 2022 Albuquerque Journal

New Mexico’s Top Organics-Ultra Health and six medical patients have filed a lawsuit arguing that insurers should assume the cost of medical cannabis because of their 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 Healthcare of New Mexico, Presbyterian Health Plan. , Presbyterian Insurance Co. and Western Sky Community Care – for not covering the medical costs of cannabis.

The plaintiffs are “for all patients who illegally pay the full cost of cannabis needed to cure themselves and all other patients with similar behavior or mental health, in violation of state law.”

“The idea of ​​health insurance plans to pay for medical cannabis seems like an impossible dream, but all the basics are already in place,” Duke Rodriguez, president and CEO of Ultra Health, said in a statement Monday. “Revolving behavioral health care in New Mexico will only take a few small steps, rather than a giant leap.”

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

Presbyterian Health Plan and Presbyterian Insurance Co., which are subject to the same leadership structure, also declined to comment.

“The Presbyterian Health Plan is committed to providing access to the behavioral health services that New Mexico needs,” said spokeswoman Melanie Mozes. “We have not yet notified the case and will keep the comments in the right place.”

The heart of the matter, according to Rodriguez, comes from legislation passed in 2021. Governor Michelle Lujan Grisham’s 317 bill signed by Governor Michelle Lujan Grisham in April 2021 is based on sharing the costs of behavioral health. The law, which came into force on January 1, states that insurance must cover 100% of behavioral health services, including prescribed treatment for a behavioral health condition.

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

In February, Ultra Health sent a letter to New Mexico Health Insurance and the Office of the Superintendent of Insurance that cannabis coverage is a behavioral health service under the law. But Ultra Health said the state and insurance companies have not yet responded to the letter.

Rodriguez said the lawsuit opens the door for more medical patients to enter.

“The legal obligation to eliminate cost-sharing related to behavioral health services will identify more patients who have been harmed by insurance providers,” Rodriguez said. “Insurers have not acted in good faith.”

Among the six medical patients listed as complainants is the state senator Jacob Candelaria.

Candelaria, according to the lawsuit, has been ill since 2019 on the orders of her doctor, who recommended the use of cannabis to help treat post-traumatic stress disorder after little success in using antidepressants.

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

In an interview with the Journal on Monday, Candelaria described her experience with medical cannabis to treat her PTSD, saying it has had a positive impact on her life. He said he did not sign the lawsuit for his own benefit, but rather in the struggle to pay for health care for “many new Mexicans.”

“The 317 Senate bill was transformative,” Candelaria said. “This suit, you know, makes it necessary to actually carry out that transformation.”

Other plaintiffs include Tomas Lorenzo Valencia, Bryce Bryant-Flynn, Matias Trujillo, Erica Rowland and Ariel McDougal, all of whom are ill doctors.

Medical cannabis became legal in New Mexico under the then government. Bill Richardson signed legislation in 2007 known as the Lynn and Erin Compassionate Use Act.

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