Opinion ID: 6317310
Heading Depth: 2
Heading Rank: 2

Heading: J.W.’s Treatment

Text: Over a two-year period from July 2015 to July 2017, J.W. received residential treatment to address mood and behavior issues. Until that time, he’d never received inpatient psychiatric treatment, despite years of medication and counseling. J.W. was first admitted to residential treatment at Change Academy at Lake of the Ozarks (“CALO”) after experiencing behavioral issues, including “struggl[ing] with emotional regulation, depression, anxiety, anger and general mood swings.” J.A. 2353. At that time, he’d been diagnosed with disruptive mood dysregulation disorder, generalized anxiety disorder, attention-deficit/hyperactivity disorder, and an unspecified neurodevelopmental disorder. Two months before the coverage periods at issue in this case, he was moved from CALO 2 The external appeal is governed by other deadlines and criteria that are not at issue in this case. 4 to an area hospital because he had suicidal thoughts and had threatened to kill himself, though he was released back to CALO after a four-day stay. This case involves claims for coverage of J.W.’s residential treatment at CALO from December 1, 2015 (when United took over the Plan’s administration) until July 31, 2017 (when J.W. was discharged). As discussed in the analysis that follows, the parties and the district court divided Wilson’s claims into three groups based on the dates of service (“DOS”). The First DOS encompasses services CALO provided from December 1, 2015, through May 15, 2016. The Second DOS encompasses services CALO provided for three periods in 2016: July 16–31, 2016; August 1–15, 2016; and November 1–30, 2016. The Third DOS encompasses all other dates of services CALO provided from May 15, 2016, through J.W.’s discharge.