Opinion ID: 777312
Heading Depth: 3
Heading Rank: 1

Heading: Discretion in the Plan

Text: 21 The Plan invokes discretion by defining Medically Necessary as those services which,  as determined by [the] ... Medical Director,  meet four listed requirements. (emphasis added). This phrase grants Oxford discretionary authority as to determinations of what is Medically Necessary, but does not afford Oxford broader discretion to construe other Plan terms. Thus, while this Court will review determinations of medical necessity with deference to the findings of the Medical Director under an arbitrary and capricious standard, see Zuckerbrod, 78 F.3d at 49, it will review other exercises of the agreement de novo, see Bruch, 489 U.S. at 115, 109 S.Ct. 948. Even under de novo review, however, the Fays' claim that the Plan generally provides the 24-hour home health care requested fails.