2012 Notable Cases

2012 has been a fruitful year for mental health insurance advocacy throughout the country. Psych-Appeal has taken the lead in holding insurers and health plans accountable to their beneficiaries by spearheading anti-discrimination litigation in California and the federal second circuit.

The first federal court decision involving a health plan’s utilization review procedures and the federal mental health parity law is expected any day, potentially reversing the long streak of discretion insurers/plans have enjoyed in discriminating against mental health (and substance abuse) claimants.

Through internal plan appeals and External Medical Reviews (also known as Independent Medical Reviews), Psych-Appeal has also helped its clients obtain (nearly) immediate relief from claims denials for inpatient/residential treatment of mental health and substance use disorders, resulting in hundreds of thousands of dollars being paid to treat life-threatening conditions.

2013 will usher in more class action litigation throughout the country against UnitedHealthcare and its subsidiaries, United Behavioral Health and Optum Health Behavioral Solutions, for a variety of discriminatory conduct against mental health and substance abuse claimants.

Psych-Appeal will also pursue legal action against Independent Review Organizations (“IROs”) that fail to maintain neutrality and/or their statutory obligations to claimants in External Medical Review assessments. Psych-Appeal is especially alert to IRO conflicts of interests where the Federal External Review Process is used by self-insured health plans, who contract directly with IROs rather than use state-administered external review procedures.