Far too many of us do not have access to the mental health care we need, even if we have health insurance, and especially if we are members of a minority group. Efforts to achieve true mental health parity through legislation and litigation, as well as individual and organizational advocacy, are central to addressing these health disparities and increasing access.
Mental health parity describes the equal treatment of mental health conditions and substance use disorders in insurance plans. (Definition courtesy of NAMI)
Medical Director/CEO Eric M. Plakun, MD
, has been a vocal and effective advocate for mental health parity, both at Austen Riggs and in his leadership positions in the field of psychiatry. In fact, Dr. Plakun was recently re-elected to a second three-year term as the American Psychiatric Association (APA) Area 1 Trustee, running on a platform largely dedicated to reducing health disparities, increasing access to care, and more fully implementing the mental health parity law by embracing the landmark verdict in Wit v. United Behavioral Health (UBH)
(discussed later in this piece).
By way of background, the Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law in 2008. This important piece of legislation made clear: if an insurance policy covers mental health and substance use disorders, then the barriers to access treatment cannot be substantially more stringent than those to access medical and surgical care. In other words, the quantitative (e.g., number of office visits or inpatient days) and non-quantitative
(e.g., hurdles like prior authorization or concurrent review) limits applied to access to mental health care must be comparable to those applied to medical coverage. The “Final Rules” of the MHPAEA and the Affordable Care Act (ACA) both helped strengthen the parity law, but enforcement to-date has been inconsistent and minimal. Litigation is now helping to remedy this.
Wit v. UBH (in which Dr. Plakun served as plaintiffs’ expert) is a landmark federal class action lawsuit tried in October 2017 that charged UBH with breach of its fiduciary duty to its insureds when it used overly restrictive access to care guidelines to deny mental health and substance use treatment. The court found that UBH focused excessively on crisis stabilization rather than appropriate treatment of patients’ full clinical pictures. In November 2020, in the trial’s remedy phase, Chief Magistrate Judge Joseph Spero issued a stinging rebuke to UBH, compelling them to reprocess over 50,000 claims and imposing a 10-year injunction against UBH during which a court-appointed Special Master will oversee and correct UBH practices. This major victory for mental health parity was hailed as a “game changer” by former Congressman Patrick Kennedy, and not only for those involved in this case. More than good news, the verdict is also a powerful tool for individual clinicians and patients appealing denials of medically necessary care, as well as for professional organizations that can use the verdict to reassert their authority over the proper elements of access to care criteria.
Individual & Organizational Advocacy
The Wit v. UBH ruling curbs the power of insurance companies to decide what standards of care are consistent with generally accepted standards. If professional organizations join the court’s assertion that real treatment is more than crisis stabilization, there is hope that the impact of the verdict will extend beyond UBH to other ERISA (employer) insurance plans, to commercial insurance, Affordable Care Act, Medicare, and Medicaid plans, thus increasing access to care, more fully implementing parity, and reducing health disparities.
Individual caregivers can also harness the verdict to advocate for and advance access to medically necessary care for their patients. But, that may be easier said than done. Fortunately, there are a number of excellent resources available to help, including a 4-point toolkit Dr. Plakun developed for appealing denials of medically necessary care, referenced below. Knowing clinicians’ and patients’ rights and how to exercise them are critical parts of achieving mental health parity.
- Use the patient’s voice as a party to a binding contract.
- Anchor appeals to third-party resources.
- Invoke the parity law.
- Reference the Wit v. UBH verdict.
Specific details on how to use these four points can be found here
There are countless resources on mental health parity–a cursory internet search will bring up many guides, toolkits, videos, and more from reputable government, professional, and non-profit entities.
A select few are listed below: