Court Finds UnitedHealthcare Illegally Denied Treatment for Behavioral Health Care. This is a Huge Win for Families.

parity addiction

Parents have likened it to a nightmare. Struggling to get your child addiction treatment, find the right facility and hope that she does not die in the process. On top of this frightening scenario, you have to worry about money. You have to fight to get life-saving treatment covered by insurance. You have to deal with time limits and prior authorizations. Mental health conditions and substance use disorders have long been on the fringe of the medical mainstream, and discriminatory insurance practices persist, creating barriers for patients seeking care. Not only is this unconscionable; often, it is illegal.

The Mental Health Parity and Addiction Equity Act (the Parity Act) became law more than a decade ago in 2008, prohibiting insurance plans from imposing more restrictive standards on mental health and substance use disorder benefits than they impose on similar medical/surgical benefits. There are additional federal and state laws that impose requirements on how insurance plans cover behavioral health services and medications (e.g. prohibit or limit the use of prior authorization).

For many reasons, we are still advocating for stronger enforcement and better implementation of these laws. The good news: we’ve just had a big win for families. Earlier this week, a federal judge found UnitedHealthcare illegally denied patients behavioral care by using defective criteria to evaluate medical necessity for treatment. The judge found that the standards UnitedHealthcare used to evaluate the need for treatment were inconsistent with generally accepted standards for outpatient, intensive outpatient, and residential treatment. In addition, the judge determined UnitedHealthcare adopted standards that prioritized cost-savings over the best interests of its members.

Many people are unaware that they have these rights when it comes to behavioral health care coverage. Bill Williams, who lost his son William to an overdose in 2012, shared his thoughts on the decision: “May this decision encourage more families who have been denied treatment by their insurer to seek recourse through our legal system. May it become a template for more attorneys to champion those who have been denied.” There is still more work to be done on Parity Act enforcement and to make quality treatment more accessible and affordable, but we should celebrate this tremendous victory for families.

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Courtney Gallo Hunter, M.P.A., is a passionate activist for those struggling with mental health issues and addiction. She works to amplify the voices of the millions of families impacted, bringing their stories to those on Capitol Hill and elsewhere as a part of our efforts to demand the resources, support and protections they need.

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