--- title: "Psychiatry Expert Not Allowed to Opine on Skilled Nursing and Inpatient Rehabilitation Guidelines" meta: "og:description": "The psychiatry expert was precluded from opining on the MCG criteria for skilled nursing and inpatient rehabilitation facilities " "og:title": "Psychiatry Expert Not Allowed to Opine on Skilled Nursing and Inpatient Rehabilitation Guidelines" author: "Shuva Guha Thakurta" description: "The psychiatry expert was precluded from opining on the MCG criteria for skilled nursing and inpatient rehabilitation facilities " --- # Psychiatry Expert Not Allowed to Opine on Skilled Nursing and Inpatient Rehabilitation Guidelines Posted on August 4, 2026 by Shuva Guha Thakurta Plaintiff B.M. challenged Defendant Anthem Blue Cross and Blue Shield's ("Anthem") determination that his daughter C.M.'s residential treatment was not a covered benefit under B.M.'s health benefit plan. Anthem based its decision on the "MCG guideline Residential Behavioral Health Level of Care, Child or Adolescent (ORG: B 902 RES)" (the "MCG RTC Guideline"), concluding that C.M. "was not at risk for serious harm without 24-hour care" and thus was ineligible for an RTC like Uinta. Anthem filed a motion to exclude certain opinions of B.M.'s expert, [Jeffrey A. Kovnick](https://expertwitnessprofiler.com/expert-witness/Jeffrey-Kovnick/1569718), MD under [Rule 702](https://www.law.cornell.edu/rules/fre/rule_702#:~:text=Rule%20702%20sets%20forth%20the,is%20a%20relatively%20narrow%20inquiry.). ![Psychiatry Expert Not Allowed to Opine on Skilled Nursing and Inpatient Rehabilitation Guidelines](https://media.jurimatic.com/images/blog_pic_640X480_2026_08_04T202929_2761.webp) ## Psychiatry Expert Witness [Jeffrey Arnold Kovnick](https://expertwitnessprofiler.com/expert-witness/Jeffrey-Kovnick/1569718), MD has had many positions over the years, including 25 years of experience working as Medical Director of several Residential Treatment Centers (RTCs) in Utah. Kovnick is a Medical Doctor (MD) with specialties and board certifications in General Psychiatry, Child & Adolescent Psychiatry, and Forensic Psychiatry. [Want to know more about the challenges Jeffrey Kovnick has faced? Get the full details with our Challenge Study report](https://expertwitnessprofiler.com/order/add?eId=1569718&pId=3). ## **Discussion by the Court** ### A. Generally Accepted Standards of Care Anthem sought to exclude Kovnick's opinion "that the standards and criteria Anthem used to determine the medical necessity of residential treatment 'violated generally accepted standards of care' because [the] standards [used by Anthem] are 'flexible' and subject to interpretation, and because they are standards 'appropriately applied to inpatient acute care.'" Compliance with generally accepted standards of care is still relevant to B.M.'s Parity Act claim to the extent that it informs whether the "limitations on benefits for mental health treatment are 'more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan.'" While the bare fact that Anthem applied requirements inconsistent with generally accepted standards of care to mental health benefits does not necessarily entail a Parity Act Violation, it still can be probative of whether there was a cognizable disparity if the analogous medical and surgical requirements were consistent with generally accepted standards. Therefore, the Court denied Anthem's request to exclude Kovnick's opinions about generally accepted standards of care. Even if not determinative, these opinions are still probative of whether Anthem engaged in illegal disparate treatment. ### B. Acute Inpatient Requirements Anthem sought to exclude "Kovnick's opinion that Anthem's medical-necessity standards for RTCs, including the MCG RTC Guideline, constitute 'acute hospitalization' criteria that are inappropriate to evaluate RTC admission" on the grounds that the opinion is unreliable. Here, Anthem argued that there is an inconsistency between (1) Kovnick's opinion that the standards Anthem used, which required symptoms such as danger to self or other, would be interpreted by most examiners as a "standard most appropriately applied to inpatient acute care" and (2) his deposition testimony where he acknowledged that individuals with the symptoms identified in the MCG RTC Guideline and Anthem's denial letter may be appropriately treated at lower levels of care depending on other relevant factors. Kovnick merely opined that Anthem's practice of requiring the symptoms listed in the MCG RTC Guideline is "more appropriate" for acute inpatient care and thus is an inappropriate requirement for lower levels of care. He in no way suggests that the presence of one of the symptoms in the MCG RTC Guideline automatically renders acute inpatient care appropriate. Thus, there are two relevant opinions expressed by Kovnick that are easily reconcilable: (1) his opinion that requiring the presence of the symptoms listed in the MCG RTC Guideline as necessary for treatment is only appropriate for acute inpatient care; and (2) his opinion expressed in deposition testimony that the presence of the symptoms is not always sufficient for rendering acute inpatient care appropriate, depending on the specific patient's support system and other personal details. Seeing no inconsistency, the Court denied Anthem's request to exclude Kovnick's opinion that the MCG RTC Guideline's medical necessity criteria are inappropriate for RTC admission. ### C. Skilled Nursing and Inpatient Rehabilitation Facilities Finally, Anthem sought to exclude Kovnick's opinion that the MCG criteria for skilled nursing and inpatient rehabilitation facilities exclude patients with acute symptoms on the grounds that it is unreliable. B.M. "does not contest" the exclusion of this opinion and acknowledges that the skilled nursing and inpatient rehabilitation guidelines are outside the scope of his expertise. Therefore, the Court granted Anthem's request for exclusion with respect to Kovnick's opinions regarding the MCG criteria for skilled nursing and inpatient rehabilitation facilities. ## **Held** The Court granted in part and denied in part Anthem's motion to exclude the testimony of Jeffrey A. Kovnick, MD. ## Key Takeaway Generally accepted standards of care may inform the factfinder's analysis of whether a difference in treatment limitations is merely "slight" or instead is a "material" disparity that is cognizable under the Parity Act. ## Case Details: | Case Caption: | B.M. V. Anthem Blue Cross | | --- | --- | | Docket Number: | 2026 U.S. Dist. LEXIS 169630 | | Court Name: | United States District Court for the District of Utah | | Order Date: | July 29, 2026 | --- ## **You Might Also Like** ![Psychiatry Expert Not Allowed to Opine on Skilled Nursing and Inpatient Rehabilitation Guidelines](https://media.jurimatic.com/images/blog_pic_640X480_2026_08_04T202929_2761.webp) [**Psychiatry Expert Not Allowed to Opine on Skilled Nursing and Inpatient Rehabilitation Guidelines**](https://expertwitnessprofiler.com/psychiatry-expert-not-allowed-to-opine-on-skilled-nursing-and-inpatient-rehabilitation-guidelines/psychiatry-expert-not-allowed-to-opine-on-skilled-nursing-and-inpatient-rehabilitation-guidelines)![Roofing Expert Allowed to Opine on Weather Damage ](https://media.jurimatic.com/images/blog_pic_640X480_2026_08_04T150950_5901.webp) [**Roofing Expert Allowed to Opine on Weather Damage **](https://expertwitnessprofiler.com/psychiatry-expert-not-allowed-to-opine-on-skilled-nursing-and-inpatient-rehabilitation-guidelines/roofing-expert-allowed-to-opine-on-weather-damage-)![Dermatology Expert Not Allowed to Opine on DMDM-induced Dermatitis](https://media.jurimatic.com/images/blog_pic_640X480_2026_08_03T200114_366.webp) [**Dermatology Expert Not Allowed to Opine on DMDM-induced Dermatitis**](https://expertwitnessprofiler.com/psychiatry-expert-not-allowed-to-opine-on-skilled-nursing-and-inpatient-rehabilitation-guidelines/dermatology-expert-not-allowed-to-opine-on-dmdm-induced-dermatitis)![Hospitality Expert Not Allowed to Opine on Food Safety Regulations](https://media.jurimatic.com/images/blog_pic_640X4802.webp) [**Hospitality Expert Not Allowed to Opine on Food Safety Regulations**](https://expertwitnessprofiler.com/psychiatry-expert-not-allowed-to-opine-on-skilled-nursing-and-inpatient-rehabilitation-guidelines/hospitality-expert-not-allowed-to-opine-on-food-safety-regulations)![Emergency Management Expert Allowed to Opine on Public Safety Communications](https://media.jurimatic.com/images/blog_pic_640X480_2026_07_31T200905_3121.webp) [**Emergency Management Expert Allowed to Opine on Public Safety Communications**](https://expertwitnessprofiler.com/psychiatry-expert-not-allowed-to-opine-on-skilled-nursing-and-inpatient-rehabilitation-guidelines/emergency-management-expert-allowed-to-opine-on-public-safety-communications)