When it comes to illness or injury, many of us are able to find good treatment within a relatively short time frame. There certainly are problems and challenges with the universal health care systems, but in the industrialized world most of us can and do find treatment providers in short order. That does not seem to hold true when we examine one aspect of health…..that of mental health. Laws and policies are enacted, psych drugs are promoted, yet the task of receiving quality mental health care treatment is still a daunting task for most. A recent poll being undertaken here in the blogosphere by Mental Health Writers Guild gives us a small snapshot by showing that the largest percentage of respondents waited over one year before getting an acceptable mental health diagnosis. This is admittedly a very complicated problem that belies a quick solution. But to solve this problem, we need to look at all the different factors that contribute to it. I present here one aspect of the problem…..that of insurance companies putting up roadblocks or even denying mental health care treatment. Attention is now being drawn to this issue by way of a class action lawsuit against one of America’s largest insurance companies…..United Health.
UnitedHealth Sued Over Mental Health Parity
By Kathleen Struck, Senior Editor, MedPage Today
Published: March 13, 2013
Health insurance giant UnitedHealth Group has been sued in a class action for alleged violations of federal and state parity laws that mandate coverage for mental health claims on a level comparable to medical and surgical benefits.
“Despite United’s duty to adhere to these anti-discrimination safeguards, United has systematically implemented unlawful and deceptive practices designed to create the illusion of impartiality, fairness, and due process while simultaneously undermining access to treatment for the most vulnerable segment of our society,” stated the suit filed Tuesday on behalf of the New York State Psychiatric Association and three patients.
The plaintiffs allege that the defendants — UnitedHealth, UHC Insurance, United Healthcare of New York, and United Behavioral Health, referred to collectively in the suit as “United” — engaged in unlawful and deceptive practices that include “undisclosed algorithms to identify high-use beneficiaries” and coverage decisions based on “internal policies that violate federal mental health parity laws.”
The suit, filed in the U.S. District Court for the Southern District of New York, in New York City, asked that United be made to comply fully with the parity laws and reimburse any claims that were unfairly denied, with interest.
Co-counsel Meiram Bendat said United “applies disparate medical necessity definitions” and “reserves unfettered discretion for itself to reject mental health claims.” Bendat, an attorney and psychotherapist in Los Angeles, said he helps patients fight insurer denials of mental health treatment.
United has “developed its own standards of care for mental health treatment that are inconsistent with prevailing, national standards and those adopted by specialty groups within the mental health community,” he said.
United had no comment on the specifics of the lawsuit. “We are committed to helping people with mental health issues reach long-term recovery,” said United spokesperson Brad Lotterman, in Minneapolis, Minn. “We recently received the complaint and are currently reviewing [it].”
Bendat called the case “monumental … by virtue of being the first to invoke the federal parity law. It is also on an enormous scale because it potentially impacts most, if not all, [United] policyholders — and that’s in the tens of millions.” United insures more than 70 million people in the U.S., according to its corporate website.
The suit alleges federal violations of the Affordable Care Act (ACA) as well. United failed to pay for concurrent care claims while internal insurer appeals were being determined, as the ACA mandates, the suit alleged.
The ACA also mandates time frames for beneficiaries to contest adverse insurance decisions, he said, and United ignored those parameters.
Bendat, founder of a California-based mental health insurance advocacy service, Psych-Appeal, said insurers rely on the psychological vulnerabilities of mental health beneficiaries. “They are the easiest group to railroad when it comes to denying care. That’s built into United’s model in doing business with respect to mental health,” he said.
Seth Stein, executive director of the New York State Psychiatric Association, in Garden City, N.Y., said the association received several complaints about recent changes in CPT [Current Procedural Terminology] codes for physician services for which United was not properly reimbursing physicians. Stein said the complaints related to “noncompliance with state and federal parity laws.”
“Over that past year or so, more, we’ve brought all of these issues to the attention of United,” he said, “and we have been unable to resolve them satisfactorily. … We are very pleased we have an opportunity to … get some assistance from the court enforcing state and federal parity law.”
If you have experienced this particular type of discriminatory practice, please speak up. Acknowledging this problem is the first step toward change. Taking action is the next. Let’s keep on going.
- Neglecting The Mental Health Analysis (prideinmadness.wordpress.com)
- NY Docs Lead Class Action Against UnitedHealth Group. People Cheer. (forbes.com)