Original publication: November 5, 2020
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
- "UBH Ruling Called an Enormous Victory for Patients, Wake-Up Call to Insurers" (Psychiatric News, November 24, 2020)
- "California Passes Law Based on Wit v. UBH Case" (Psychiatric News, November 24, 2020)
- “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
13 years after Congress passed the Mental Health Parity and Addiction Equity Act, psychiatric professionals and patients still wrangle with insurance providers to pay for medically necessary—and legally mandated—coverage. Writing in the Journal of Psychiatric Practice, four authors with medical, legal, public-policy, and personal experience in this area provide expert advice as well as letter templates and suggested text that you can access and download for FREE.
Insurance companies regularly deny access to mental health treatment that you determine to be medically necessary for your patients. In this presentation, Eric Plakun, MD explores the “game-changing” impact that the verdict in the Wit v. United Behavioral Health class action suit can have on access to care and insurance coverage for your patients.New APA-Backed Federal Parity Law Is a Game Changer
APA-backed federal legislation enacted in December 2020 gave the federal government powerful new authority to enforce the law that requires insurers to provide the same access to psychiatric treatment as other medical care for patients they cover. For anyone who’s struggled to find psychiatric care, or has found it too expensive to afford, this law, strengthening mental health parity, is a game changer. Learn more at psychiatry.org/parity
In November 2020, a federal magistrate judge issued a stinging rebuke to the United Behavioral Health division of UnitedHealth Group, the nation's largest behavioral health insurer, saying it could no longer use its overly restrictive guidelines to deny mental health and substance use treatment and compelled them to reprocess over 50,000 claims. In this webinar, three experts with intimate knowledge of the case, Meiram Bendat, Joe Parks, and Eric Plakun, discuss how the ruling curbs the power of insurance companies to decide what standards of care are appropriate, and provide insights on how caregivers can use the verdict to advance access to care for their patients.
In this video, Austen Riggs Medical Director and CEO Eric M. Plakun, MD, who served as plaintiffs’ expert in Wit v. United Behavioral Health, details how the order hands clinicians and professional groups a powerful tool to reclaim their role in determining access to care for patients.
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.