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DOE v. HARVARD PILGRIM HEALTH CARE, INC.

No. 17-2078.

904 F.3d 1 (2018)

Jane DOE, Plaintiff, Appellant, v. HARVARD PILGRIM HEALTH CARE, INC.; Harvard Pilgrim PPO Plan Massachusetts, Group Policy Number 0588660000, Defendants, Appellees.

United States Court of Appeals, First Circuit.

September 6, 2018.

Attorney(s) appearing for the Case

Mala M. Rafik , with whom Sarah E. Burns and Rosenfeld & Rafik, P.C., Boston, MA, were on brief, for appellant.

Peter S. Sessions , Lisa S. Kantor , and Kantor & Kantor LLP, Northridge, CA, on brief for National Alliance on Mental Illness, amicus curiae.

Jonathan M. Feigenbaum , Boston, MA, on brief for United Policyholders and Health Law Advocates, Inc., amici curiae.

Christine Zaleski , with whom Steven L. Schreckinger , Boston, MA, and Anderson & Kreiger LLP were on brief, for appellees.

Before Thompson, Selya, and Kayatta, Circuit Judges.

Jane Doe's insurer, Harvard Pilgrim Health Care ("HPHC"), deemed part of the time Doe spent at a mental health residential treatment facility not medically necessary under the health care benefits plan established by the employer of Doe's parent. HPHC therefore denied coverage for that portion of the treatment. After several...

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