The American Psychiatric Association (APA) has filed a “friend of the court” brief with the U.S. Court of Appeals for the Second Circuit in support of a lawsuit that is associated with Psych-Appeal. The amicus brief backs the New York State Psychiatric Association’s (NYSPA) appeal of a lower court decision regarding a lawsuit filed against United Behavioral Health for allegedly violating the federal parity law.

In its brief, APA supports NYSPA’s position that it can bring a claim under ERISA on behalf of  member psychiatrists and their patients.

“Psychiatrists have third-party standing to assert claims on behalf of their patients because: they suffer injury themselves; they stand in a ‘close relationship’ with the patients on whose behalf they seek to litigate; and those patients face ‘some hindrance to. . .asserting their own rights,’ ” states the APA. “…social stigma and the inherent incapacities associated with mental health and substance use disorders constitute a substantial and often insurmountable obstacle to patients’ efforts to vindicate their own rights through litigation. These deterrent effects are supported by the scientific literature and have long been recognized by the courts. As a result, just as courts have recognized the third-party standing of nonpsychiatric doctors to litigate on behalf of patients, courts also have recognized the standing of psychiatrists to do the same.”

The initial class action, which was filed in March 2013 by NYSPA, Psych-Appeal, and others, alleges that UnitedHealth Group and its subsidiaries, including United Behavioral Health, routinely violated the federal parity law.

On September 11, 2014, the Guilford Press, publisher of Psychodynamic Psychiatry, released a “Special Issue on Psychotherapy, the Affordable Care Act and Mental Health Parity: Obstacles to Implementation.”  The Special Issue is of substantial psychiatric and public health relevance, observing an area that requires sustained attention and action from the mental health community. Guilford Press will make the attached Special Issue available online at no charge to the public for the next two months.

The Special Issue includes articles addressing insurance company practices that are not consistent with evidence-based treatment because of their conflicting cost priority—both in violation of the law and in contra-distinction to research and professional treatment guidelines.

The Special Issue also includes articles addressing the research data on the efficacy and cost-effectiveness of psychotherapy for the major psychiatric diagnoses and with special focus on the enormous challenge of the mental health needs of military service members and veterans, the current practice environment which confronts providers of psychotherapy, the impact on workers’ productivity of untreated psychiatric illness, and obstacles to the training of psychotherapy to residents in psychiatry.

Meiram Bendat’s article, “In Name Only?  Mental Health Parity or Illusory Reform,” leads the charge.

Psych-Appeal, in conjunction with Zuckerman Spaeder LLP and The Maul Firm, P.C., filed a nationwide class-action lawsuit against United Behavioral Health (doing business as OptumHealth Behavioral Solutions) on behalf of mental health and substance abuse claimants. The ERISA suit alleges UBH’s breach of fiduciary duties in promulgating overly restrictive medical necessity criteria that do not comport with prevailing, evidence-based clinical standards.

Read the amended class action complaint.

Related coverage:

Class action suit against UnitedHealthcare examines how parity is applied, Behavioral Healthcare, June 2, 2014

Class Action Complaint: UnitedHealthcare Violated Federal Mental Health Parity Law, Bloomberg, May 27, 2014

UHC Mental Health Coverage Denials Violate ERISA, Suit Says, Law360, May 21, 2014

Psych-Appeal and its collaborating counsel have filed a first-of-its-kind class action complaint against Health Care Service Corporation in the United States District Court of Illinois, Northern District. The complaint alleges that Health Care Service Corporation improperly denies Transcranial Magnetic Stimulation (TMS) for insureds afflicted by Major Depressive Disorder, a severe and disabling mental illness that does not always respond to first line treatments.

Although TMS is an FDA-approved, scientifically-validated treatment that is well-recognized by the mental health community, the class-action complaint alleges that HCSC continues to exclude TMS in violation of plan terms and the Employee Retirement and Income Security Act of 1974. HCSC is also alleged to violate the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 by requiring preauthorization for all outpatient mental health services without requiring the same for all outpatient medical/surgical services.

On December 31, 2013, Psych-Appeal and its collaborating counsel filed a class-action suit against the Lovelace Health Plan. Plaintiffs allege a categorical violation of the New Mexico Mental Health Parity Law by the Lovelace plan for excluding residential treatment from group health coverage while offering extended 24-hour treatment for subacute physical conditions. This is the first mental health parity suit brought in New Mexico.