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Zuckerman Spaeder LLP and Psych-Appeal, Inc. File Class Action Lawsuits Against Aetna and Cigna for Allegedly Denying Depression Treatment

Cases Among First to Question Bias of Independent Review Organizations

September 11, 2015

Zuckerman Spaeder LLP, in conjunction with Psych-Appeal, Inc., has filed separate class action lawsuits against Aetna and Cigna on behalf of mental health patients suffering from depression. The federal lawsuits allege that the insurers have categorically refused to cover a safe and effective treatment called Transcranial Magnetic Stimulation (TMS).

“We claim that these insurers have unjustifiably categorized TMS as ‘experimental and investigational’ while Medicare and numerous commercial insurers routinely cover it,” said D. Brian Hufford, partner at Zuckerman Spaeder LLP. “By denying coverage for TMS, Aetna and Cigna are preventing patients from receiving potentially lifesaving care.”

In 2008, the U.S. Food and Drug Administration cleared TMS for patients who have failed to respond to psychotropic medications. Unlike electroshock therapy, TMS is performed on an outpatient basis without sedation and does not typically result in side effects such as memory loss.

The complaints against the insurers also allege that MCMC, LLC, an independent review organization directly contracted with Aetna and Cigna to evaluate external appeals of the insurers’ TMS denials, rubber-stamps the insurer by relying on outdated clinical research.

“These cases will be among the first to highlight the conflicts of interest that independent review organizations have when they are allowed to contract directly with insurers to evaluate claim denials,” said Meiram Bendat, mental health attorney and founder of Psych-Appeal, Inc.

The class action against Aetna has been filed in New Haven, Conn. with co-counsel Elizabeth K. Acee and Daniel P. Elliott of Connecticut-based LeClairRyan P.C. The class action against Cigna has been filed in Los Angeles, Calif.

The Zuckerman Spaeder team includes partners Brian Hufford and Jason Cowart and associate Andrew Caridas.

Interested parties may contact Brian Hufford at dbhufford@zuckerman.com or Meiram Bendat at mbendat@psych-appeal.com.

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