EmblemHealth Sued for Alleged Violations of New York Mental Health Parity Law

Psych-Appeal and Zuckerman Spaeder LLP filed a new mental health parity lawsuit in New York today against EmblemHealth, Inc., which insures the employees of the City of New York and which has contracted with ValueOptions to administer its behavioral health benefits. The complaint alleges that EmblemHealth, acting through ValueOptions, fails to provide coverage for “serious emotional disturbances” of children, as required by the New York mental health parity law, also known as Timothy’s Law.

While EmblemHealth and ValueOptions publish prevailing clinical guidelines for the treatment of biologically based mental illnesses, such as major depression, on their websites, they do not publish prevailing clinical guidelines for the treatment of Oppositional Defiant Disorder and Conduct Disorder. These disruptive disorders often require intensive psychosocial rehabilitation to address their hallmark symptoms, namely oppositionality and defiance.

The suit challenges EmblemHealth’s coercive insistence on psychotropic medications, even when such medications are not a first-line treatment for serious emotional disturbances of adolescents who must generally establish strong therapeutic alliances prior to medication trials.  The suit also alleges that EmblemHealth abdicates its role to provide inpatient coverage by directing adolescents with serious emotional disturbances for long-term treatment in state hospitals.

EmblemHealth and ValueOptions both entered into Assurances of Discontinuance with the New York Attorney General in 2014 and 2015 for violating the New York and federal mental health parity laws.