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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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