press release by the American Psychiatric Association. The court held that the “Parity Act was promulgated to eliminate impermissible disparity in the benefits afforded for mental health and substance abuse disorders when compared to those afforded medical/surgical conditions.”]]>
On March 11, 2013, a federal class action suit against UnitedHealthGroup and its subsidiaries, UnitedHealthcare and United Behavioral Health (doing business as OptumHealth Behavioral Solutions), was filed in the United States District Court for the Southern District of New York. The suit, brought by the New York State Psychiatric Association and employees of the State University of New York, CBS, and SYSCO, alleges that United routinely violates federal and state antidiscrimination laws protecting critical access to mental health services. The plaintiffs also assert that United applies sham practices to circumvent claims processing and reimbursement rules.
APA Psychiatric News issues alert and case coverage.
View commentary on the suit by Forbes, MedPage Today, and Children’s Mental Health Network.
Psych-Appeal receives approval as a Continuing Education Provider by the California Board of Behavioral Sciences. Web-based mental health advocacy training content will soon be streamable.
Continuing Education in mental health insurance advocacy will soon be available online by Psych-Appeal. Applications to award distance learning credit are currently pending with the California Board of Behavioral Sciences and will also be submitted to the American Psychological Association and the National Association of Social Workers.
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.
Psych-Appeal is working with Kaiser Permanente members and subscribers in California who have been wrongly denied residential treatment for mental health and substance use disorders despite recent legal rulings. We are interested in helping patients resolve such disputes and obtain compensation.
The first of its kind, a class-action suit against United Behavioral Health (UBH) was filed on May 8, 2012, alleging that UBH is in violation of several important laws protecting the rights of mental health patients. United Behavioral Health (part of United HealthCare Insurance Company) contracts with large employers like the University of California to provide mental health coverage to policyholders.
The class-action suit alleges that UBH has violated the California Mental Health Parity Act, which requires insurers to provide treatment for nine mental health diagnoses according to “the same terms and conditions” applied to medical conditions. The California Mental Health Parity Act of 2000 recognized that denial of mental health benefits could be devastating to policyholders, and also exacerbated social problems like homelessness and addiction.
The class-action suit also alleges that UBH has violated the Unruh Act, by discriminating against a class of persons with mental disabilities and psychiatric conditions, and the Unfair Competition Law. On October 24, 2012, the Santa Barbara Superior Court overruled UBH’s motion to dismiss the case, requiring the insurer to answer the plaintiff’s complaint and setting a status conference to schedule trial.
Meiram Bendat, founder of Psych-Appeal, a mental health insurance advocacy service, initiated this important consumer action along with the Los Angeles-based firm, Cohen McKeon LLP. The plaintiff is an employee of the University of California, Santa Barbara. Psych-Appeal is currently involved in the first (and only) litigation of the federal mental health parity law.
View the May 28, 2012, Forbes article chronicling this suit.
Often overlooked by healthcare providers is the California Supreme Court’s 1986 holding that physicians have a duty to appeal adverse benefit decisions made by insurers in their patients’ cases or risk the consequences of failing to do so. Psych-Appeal helps treatment providers effectively discharge this duty of care.
California’s largest legal newspaper, the Daily Journal, profiles Meiram Bendat.
Since the majority of U.S. workers are covered by self-insured health plans offered through their employers, plan participants are especially vulnerable to denials of treatment. Self-insured policies offered through private employers are generally governed exclusively by ERISA, a restrictive federal law that incentivizes plan administrators to deny claims and leaves little latitude for independent judges to overturn medical necessity determinations.
Psych-Appeal urges thorough and informed advocacy of mental health treatment claims submitted for internal reviews in ERISA cases. Failure to raise all pertinent issues during the internal appeals process can preclude any subsequent chance of recovery in court.