Opinion ID: 35610
Heading Depth: 3
Heading Rank: 2

Heading: Plan Administrator's Denial of Benefits

Text: 25 Mayeaux also contends that the Adler Plan's administrator improperly denied coverage for Dr. Hyman's prescribed therapy and that the district court erroneously affirmed that decision. We disagree. 26 As a preliminary matter, Mayeaux advances that the district court failed to apply the correct standard of review. Mayeaux maintains that the Adler Plan administrator's decision is tainted by a conflict of interest, requiring the district court to employ our Vega case's sliding scale standard of review to evaluate whether there was an abuse of discretion. 23 Mayeaux's assertion in this regard is baseless: The record makes clear that the district court expressly applied Vega and accorded the administrator's decision less than full deference. 27 The essence of Mayeaux's substantive challenge to the Adler Plan administrator's decision is that the plan's wording does not contain an express exclusion for the investigational use of drugs. Mayeaux's argument is a red herring. As we explained earlier, 24 the Adler Plan specifically excludes benefits for investigational treatments and any procedures that BCBS determines not to be standard medical treatment for that particular condition. 28 Simply put, Mayeaux has failed to identify sufficient record evidence on appeal to support the Plaintiffs' contention that HDAT, as prescribed by Dr. Hyman for the connective tissue malady that he diagnosed in Mayeaux, is standard medical treatment. Mayeaux, of course, relies on Dr. Deming's medical opinion to make this showing. Even assuming arguendo that Dr. Deming's opinion provided some additional support for the Plaintiffs' position that HDAT is not purely investigational, we certainly cannot conclude that the Adler Plan administrator's decision was an abuse of discretion. The administrator could readily have concluded, as he did, that one concurring medical opinion is inadequate to establish that HDAT is a standard medical treatment. As such, Mayeaux has failed to show abuse of discretion by the administrator of the Adler Plan, so the district court's grant of summary judgment on Mayeaux's denial-of-benefits claim was proper.