the less they hold up to the point where thousands of claims may be reprocessed using nonproprietary guidelines and to the point where such proprietary guidelines getting next year appear to be prohibited from us study that point i'm not sure how i see that that's an issue in this case the district judge the district judge said the only evidence in front of me is that the magellan guidelines and i take it also the mi guidelines are representative of the standard of care there are no contrary evidence has been given to me in this case it may turn out that they're not but did you present any evidence in the district court that these critical piece of evidence is the letter from doctor marrs that says you know my opinion is that alex needs residential care your brief says that letter was submitted in conjunction with the st to be to blue shield but as i read the record the st appeal to blue shield was decided before that letter was dat and yet i think figure out trying to figure out what your position is where the how when this letter was put before moved i jumped because the independent medical review look at it says i've got this letter from doctor parnassus that among the things that he says so i know the i r had it but when was it put in the record before blue shield if you can tell me i think the answer to that is want this i don't contrary to your brief it wasn't submitted with the st expedited appeal because it's dated after i believe it was a i don't find any reference to it anyplace else until you ask for a nd diagram or and the i am more satisfactory bushido said here's all the stuff i have in the st time is there any you know is this do you think this warrants is there anything and oh she says no so i'm still i still can't fight in this record any evidence that you gave had all this information that you've talked about the front of them they look at it nonetheless i cry interest and i think a lower level of care would would have been sufficient was you know so i'm trying to focus on just this letter because this is the treating physician that says he needs residential treatment and they should have at least have dealt with it if they were presented with that and so that's that's why i want to you know i want to be fair with you and say that's why this letter is sort of wharton's and i understand i think  that afternoon your honor may place the court can everyone see and hear me ok we can hear you just ok thank you lou let me just begin by apologizing for the technical difficulties i did i don't know what happened but i'll have to make sure it prepared remarks and go directly to answering some of judge her questions i think they really get to the heart of the matter the st question about the magellan guidelines the court is absolutely right that this case is actually a usual because in  unlike a normal risk where the claimant is limited to the administrative record or in this case the plaintiffs several chances to submit unlimited evidence to support admissible evidence after that but they actually testified that despite their best efforts they had been an eagle to marshal any evidence so yes i think that's exactly right that that whatever well there's no evidence anywhere that the magellan guidelines are faulty but  even if even if there were that's not it certainly was not before the district court and secondly your honor is correct that the morrison letter as far as we can tell from the record w submitted to the st of the d m a see on the nd i am our and that was the that was the st time that it entered the record now they did send it to blue shield and ask if that changed big show any risk of harm for this particular claimant but disagree with the conclusion that residential treatment was nonetheless the correct level of care for him every reviewer who looked at this concluded the same thing that that alex didn't need president didn't need mental health treatment that was undisputed but that there would have been a different level of care intensive outpatient which was something that he had never tried before would have been much more intensive but would not have required him to we ended we end up with a record with eight separate physicians including certified child and adolescent psychiatry all saying the same thing that alex definitely needed care he did not need residential treatment it wasn't the plan terms and is there a structural conflict the nd is if there is whether it's what extent that structural conflict factors into the analysis it depends on whether there's any evidence that it actually affected the decision and there's this separate thing that if the administrator has committed procedural errors that are so flagrant and egregious then they may apply it may justify of applying to an overview here the district court did exactly what it was supposed to do it properly determined that the standard of review  to the structural conflict but waited very little if any and all of this is perfectly consistent with the case law including a body which the court cited in its st order so i think with that we've being you can't say well they had all these opportunities