UnitedHealth Group Complaint Filed Alleging Violation of Parity Laws for Psychotherapy Services
Psych-Appeal and Zuckerman Spaeder LLP have filed a federal class-action lawsuit against UnitedHealth Group (“UnitedHealth”) and its Oxford subsidiaries, alleging violation of parity laws by imposing arbitrary reimbursement penalties on psychotherapy services provided by psychologists and master’s level counselors.
The dispute concerns the artificially reduced amounts UnitedHealth would pay for the plaintiff’s covered treatment for her eating disorder, which included individual and family counseling from a psychologist with 17 years of experience and a Licensed Clinical Social Worker (LCSW) with post-graduate training. These providers are considered out-of-network with benefits determined based on an “allowed amount,” which is the maximum amount eligible for reimbursement.
The plaintiffs in this case allege that UnitedHealth has a policy in place that 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 plaintiffs argue that with these arbitrary reimbursement penalties, UnitedHealth violates several parity laws, including the Affordable Care Act, Timothy’s Law (the New York Parity Act), and the Federal Parity Act (Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008), by discriminating against patients seeking behavioral health services from such providers.
“Psychologists and social workers form the lion’s share of the mental health workforce,” said Meiram Bendat, mental health attorney and founder of Psych-Appeal. “By artificially devaluing psychotherapy—a mainstay of outpatient mental health care—UnitedHealth Group and its Oxford subsidiaries are suppressing costs for its primary advantage, and imposing undue burdens on health plan participants and beneficiaries.”
The complaint, Doe v. UnitedHealth Group Inc. et al, was filed in the U.S. District Court for the Eastern District of New York.
Update: UnitedHealth Group Psychotherapy Reimbursement Suit Moves Ahead, August 23, 2018