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The Continuing Legal Fight for Mental Health Parity  

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Eric M. Plakun, MD, DLFAPA, FACPsych, Associate Medical Director and Director of AdmissionsAusten Riggs Center Medical Director/CEO Eric  Plakun, MD, comments on  the October 31, 2019 court filing alleging that  Health Care Service Corporation (HCSC) is using overly restrictive clinical guidelines, developed by MCG Health (MCG), to deny medically necessary residential treatment for behavioral health care.  

On October 31, 2019,  Zuckerman Spaeder  and  Psych-Appeal filed a lawsuit in the US District Court for the Northern District of Illinois  against the company that runs Blue Cross and Blue Shield plans in five states, arguing that Chicago-based HCSC is unlawfully denying behavioral health benefits to members in violation of generally accepted medical standards.  

The case comes on the heels of the  verdict  this spring  in the  Wit v. United Behavioral Health (UBH)/Optum  class-action lawsuit  in which  Chief Magistrate Joseph C. Spero found that  UBH “illegally denied mental health and substance use coverage based on flawed medical necessity criteria.” The outcome of the remedy phase of that case is still pending.  

“Wit  v. UBH  and this most recent filing represent ‘a bottom-up’  challenge to  flawed criteria insurance companies  may  use to determine coverage,”  Plakun  said. “Coupled with  such  ‘top-down’ efforts as bipartisan action in Congress to ensure mental health parity compliance, inroads are being made  in removing  barriers to  accessing medically necessary  care  faced by  many individuals and families in our country today."  

"While  Wit v. UBH  addressed  the flawed access to care criteria developed and used by the nation’s largest behavioral health insurer, this case appears to  address  similarly flawed criteria developed by MCG, which are licensed  and used by multiple insurance entities," he added. 

Mental health parity was a central topic of discussion during  The Mental Health Crisis in America: Recognizing Problems, Working Toward Solutions  conference  that Riggs hosted in the fall of 2019. It also figures prominently in the Center's  Four Freedoms of Mental Health  initiative.  

 

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