Class-Action Complaint Filed Against United HealthCare/UBH for Parity Violations
Psych-Appeal and Zuckerman Spaeder LLP have filed a class-action complaint alleging mental health parity law violations by United HealthCare Insurance Co. (“UHIC”) and United Behavioral Health (together “United”). The class action alleges that United imposed arbitrary reimbursement penalties on psychotherapy services provided by psychologists and master’s level counselors.
The dispute centers around the amount United would pay for the plaintiff’s covered treatment for her post-traumatic stress disorder, which included individual counseling from a Licensed Clinical Social Worker (“LCSW”) with post-graduate training. Since the provider was considered out-of-network, benefits were based on an “allowed amount,” which is the maximum amount eligible for reimbursement.
The plaintiff in this case alleges that United Healthcare Insurance Co. and United Behavioral Health have a policy that allegedly results in parity violations because it reduces the “allowed amount” of covered charges by 25 percent when provided by a psychologist and 35 percent when provided by a master’s level counselor (i.e., an LCSW). As a result, anyone receiving psychotherapy services from a psychologist or social worker is subject to reduced reimbursements. The plaintiff argues that these arbitrary reimbursement penalties violate the Federal Parity Act and the Affordable Care Act by discriminating against patients seeking behavioral health services from such providers.
“Outpatient psychotherapy plays a critical role in the recovery process for patients in need of ongoing mental health treatment,” said Meiram Bendat, co-counsel for the plaintiff and founder of Psych-Appeal. “United’s actions to artificially devalue the services of psychologists and social workers may boost revenues and shareholder profits, but it is a systemic denial of benefits to health plan participants and beneficiaries. Health insurance companies like United must be held accountable for flouting parity laws that were put in place to prevent such discriminatory practices.”
The complaint was filed in the U.S. District Court for the Northern District of California. Today’s filing follows a New York federal judge’s ruling in August regarding a similar complaint filed by Psych-Appeal and Zuckerman Spaeder against Oxford Health Insurance Inc., which is also owned by UnitedHealth Group.
Related coverage: United Healthcare Sued For ‘Arbitrary’ Therapy Payment Policy, Law360, October 17, 2018 (NOTE: This link is available to Law360 subscribers.)