Mental Health Parity and the Wit v. UBH Class Action Lawsuit
On February 28, 2019, Judge Joseph Spero of the United States District Court for the Northern District of California issued the findings of fact and conclusions of law in Wit v United Behavioral Health (UBH), a class action brought against the country’s largest behavioral health insurer. On November 3, 2020, Judge Spero issue a ruling related to the remedy phase of this case. Based on his knowledge and experience, Austen Riggs Center Medical Director/CEO Eric M. Plakun, MD, served as plaintiffs’ expert on adult mental disorders for this case. Dr. Plakun is an authority on access to care, implementation of mental health parity, and other advocacy issues.
Articles about Judge Joseph Spero’s November 3, 2020 Ruling
“Federal Court Orders UnitedHealth To Fix 67,000 Behavioral Health Denials” (Forbes, November 4, 2020) – features remarks from Austen Riggs Medical Director/CEO Eric Plakun, MD
“District Court Issues Injunction Against UBH for Failure to Cover Mental Health/Substance Use Disorders” (Psychiatric News, November 4, 2020)
“US Judge Orders United Behavioral Health To Revamp Behavioral Health Claims Processing” (Modern Healthcare, November 4, 2020) – requires paid subscription
“U.S. Federal Court Orders Special Master and 10-Year Injunctions for UnitedHealthcare Affiliate That Breached Fiduciary Duties” (Psych Appeal, November 4, 2020)
“After Delivering Landmark Win for Mental Health Patients, Judge Orders UnitedHealth to Reprocess Over 50,000 Claims and Reform Claims Handling” (Zuckerman Spaeder, November 3, 2020)
Background and Resources
As clinicians know, and as Federal District Court Judge Joseph Spero made part of his verdict in the landmark Wit v. UBH class action lawsuit [which we reference later in this piece], treatment should address underlying problems and co-occurring disorders in a way that goes well beyond mere crisis stabilization.
Caroline E. Reynolds, Esq., explains the theory of the case, in which UBH (Optum), the nation’s largest behavioral health claims administrator, was found liable for breaching its fiduciary duties to its insureds by developing and using medical necessity criteria that were pervasively more restrictive than generally accepted standards of care.
The National Council for Behavioral Health has developed a new toolkit to empower behavioral health providers to claim their role as an authority on generally accepted standards of care.
- Eric Plakun, MD, Medical Director/CEO, Austen Riggs Center
- Joseph Parks, MD, Vice President, Practice Improvement, National Council for Behavioral Health
- Lindsi DeSorrento, MPH, Director, Healthcare Transformation, National Council for Behavioral Health
If you receive a denial from your insurance company for mental health treatment that you and your treating clinician believe is medically necessary, there are four important tools to maximize the chances for success in an appeal.