Top Organics-Ultra Health in New Mexico and six medical patients have 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 insurers in the state – 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 cost of medical cannabis.
The plaintiffs in the case are seeking “recovery for themselves, as well as for any other patient with similar behavior or mental health, who has been illegally paid the full price of medically necessary cannabis, in violation of state law.”
“The idea of health insurance plans paying for medical cannabis may seem like an impossible dream, but all the basic elements have already fallen into place,” Ultra Health President and CEO Duke Rodriguez said in a statement Monday. “The revolution in behavioral health care in New Mexico will take just a few small steps, not a huge leap.
True Health New Mexico and the Blue Cross and Blue Shield of New Mexico declined to comment. Molina Healthcare of New Mexico, Western Sky Community Care and Cigna did not respond immediately to requests for comment.
Presbyterian Health Plan and Presbyterian Insurance Co. – who fall under the same governing structure – also declined to comment.
“The Presbyterian Health Plan is committed to ensuring that new Mexicans have access to the behavioral health services they need,” said spokeswoman Melanie Moses. “We have not yet been served with a claim and we will keep a comment on the appropriate location.”
According to Rodriguez, the heart of the case stems from legislation passed in 2021. Senate Bill 317, signed by Gov. Michel Lujan Grisham last April, focuses on sharing behavioral health costs. The law, which came into force on January 1, stipulates that insurers must cover 100% of behavioral health services, including prescribed treatment for behavioral health.
More than 73,000 medical patients out of 134,307 patients enrolled in the state’s medical cannabis program are suffering from post-traumatic stress disorder, according to data from the New Mexico Department of Health in April.
In February, Ultra Health sent a letter to health insurers in New Mexico and the Insurance Supervision Service seeking assurance that cannabis coverage was a behavioral health service under the law. But Ultra Health said the state and insurers have not yet responded to the letter.
Rodriguez said the trial opens the door for more medical patients to join.
“There will be more patients identified who have been harmed by insurers who do not legally comply with the legal obligation to eliminate any sharing of behavioral health care costs,” Rodriguez said. “Insurers did not act in good faith.”
The six medical patients listed as plaintiffs mostly include State Senator Jacob Candelaria.
Candelaria, according to the case, has been a medical patient since 2019 on the orders of his doctor, who advised him to use cannabis to 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 out of pocket since becoming a medical patient. He is insured in the Blue Cross and Blue Shield of New Mexico, according to the lawsuit.
In an interview with the magazine on Monday, Candelaria described his experience with medical cannabis in treating his post-traumatic stress disorder, saying it had had a positive effect on his life. He said he signed the lawsuit not for his own benefit, but for the many “new Mexicans struggling to pay for their health care.”
“Senate Bill 317 was transformative,” Candelaria said. “This suit, you know, is really needed to make this transformation happen.
Other plaintiffs are Thomas Lorenzo Valencia, Bryce Bryant-Flynn, Matthias Trujillo, Erica Rowland and Ariel McDougall, all of whom are medical patients.
Medical cannabis became legal in New Mexico under the then government. Bill Richardson, who signed the legislation known as the Lynn and Erin Merciful Use Act in 2007.