Court Rules for Mental Health

A federal judge ruled that United Behavioral Health created faulty medical review criteria that wrongly rejected the insurance claims of more than 50,000 people pursuing mental health and substance use disorder treatment. Due to the stigma of mental illness being not as vital as a broken arm or leg, health insurers haven’t provided as much coverage as needed historically. Now, with the ruling of Wit v. United Behavioral Health (UBH), a federal court in Northern California found that United was found liable for perpetuation of an unequal, discriminatory system of health care. This ruling shines a light on the health insurers that have denied care for those susceptible to overdose and suicide.

Over 5.3 million adults with a mental illness remain uninsured. Under the Affordable Care Act (ACA), fewer Americans are uninsured, down 2.5% from 2017, according to Mental Health America.

11 people came forward to sue the nations largest managed behavioral health company, including one person, Natasha Wit, who had sought coverage, was denied, and paid $30,000 out of pocket for her treatment for depression, anxiety and an eating disorder.

United’s criteria was ‘defected’, the court said, due to circumventing the Mental Health Parity and Addiction Equity Act of 2008, which requires insurers to cover illnesses of the brain such as addiction or depression, no more than an illness or disease of the body, in order to keep their own costs down. United also improperly required reducing the level of care consistent with clinical standards and claimed that maintaining a higher level of care was better for the patient when insurance companies shouldn’t have a say when it comes to treatment options. United also failed in following guidelines for evaluating the medical necessity of behavioral health services for the states of Connecticut, Illinois and Rhode Island.

What may result from this decision is insurers taking notice not to  discriminate against those with mental health and substance use disorders. Other payers to blame include Blue Cross Blue Shield of Kansas City, which improperly denied reimbursement for mental health treatment of the Elements Wilderness Programs back in 2016. Anthem Health Plans of Kentucky breached its fiduciary duties by failing to act solely in the interest of the Plan participants and beneficiaries when it denied a patient’s benefits and by failing to provide a fair review as required under the Plan and by ERISA.

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