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Professional News
 DOI: 10.1176/appi.pn.2013.4a21
NYSPA Is Lead Plaintiff in Suit Against UnitedHealth
Psychiatric News
Volume 48 Number 7 page 1-14

Abstract

NYSPA is representing members who say they have experienced problems associated with patient access to mental health treatment and with reimbursement for care.

Abstract Teaser

The New York State Psychiatric Association (NYSPA) has joined a class-action lawsuit against UnitedHealth Group and subsidiaries, including United Behavioral Health (UBH), for alleged violations of the federal parity law and the Affordable Care Act.

The class action, filed last month in the U.S. District Court, Southern District of New York, was brought on behalf of three beneficiaries. NYSPA joined the suit on behalf of its members and their patients.

Seth Stein, J.D., executive director of NYSPA, told Psychiatric News that the district branch has fielded numerous complaints from its members about systematic denial of mental health and substance abuse treatment by United.

“Over the past year we have tried to work with United to resolve these complaints but have been unsuccessful,” Stein said. “Enforcement of existing state and federal parity statutes is necessary to ensure that individuals with mental illness have access to appropriate care and treatment.”

He was echoed by NYSPA President Glenn Martin, M.D. “Our state andnational associations have fought for years for parity legislation, and we were mostly successful,” Martin told Psychiatric News. “That was only the first step, and now we find that we have to fight for full implementation of the laws and regulations. This lawsuit allows us to go on the offensive in this struggle, and we are confident we will prevail to the benefit of our patients and colleagues.”

A 100-plus-page formal complaint details the violations alleged by NYSPA and individual beneficiaries. These include “numerous member complaints” about United’s restrictions on psychotherapy. “NYSPA members have reported United fully curtailing psychotherapy for patients requiring long-term treatment, allowing no more than weekly psychotherapy for patients who have attempted suicide and been hospitalized (in one case a patient attempted suicide five times and was hospitalized 10 times), and refusing to cover more than one weekly session of psychotherapy for actively suicidal patients,” according to the complaint.

The document states that NYSPA members have also complained about United beneficiaries reporting “extreme difficulty obtaining initial and continuing authorizations for intermediate levels of care, such as intensive outpatient treatment and partial hospitalization for mental health and substance abuse disorders.”

Additionally, NYSPA alleges a “pattern of denying coverage for out-of-network mental health services due to purported failures by providers to respond to requests for back-up clinical information when in fact no such requests have been made.”

“This is not an isolated incident,” according to the complaint. “In each of the cases, UBH or OptumHealth asserts either in writing or over the telephone that it has repeatedly contacted either the beneficiary or the provider to obtain additional information regarding out-of-network claims, yet none of the parties report receiving any such requests for information. As a result of the alleged failure to respond to requests for information, the patient’s out-of-network claims are then denied.”

Additionally, the suit cites numerous complaints alleged by three individual beneficiaries. These include a detailed history of problems associated with obtaining treatment—or reimbursement for treatment—of a child with ADHD, bipolar disorder, delusions and hallucinations, and a history of suicidal ideation and homicidal threats.

Meiram Bendat, J.D., an attorney and psychotherapist who founded the mental health insurance advocacy service Psych-Appeal, told Psychiatric News that United’s violations are systematic and pervasive.

“United has devised multilayered strategies in which it violates parity with respect to medical necessity and level-of-care guidelines for mental health and substance abuse and deprive patients and providers meaningful due process required by the Affordable Care Act,” he said.

Bendat is counsel for the plaintiffs along with the New York law firm Pomerantz Grossman Hufford Dalhstrom and Gross.

At press time, a spokesperson for United told Psychiatric News that the company was reviewing the complaint and had no comment at the time.

Colleen Coyle, J.D., general counsel for APA, said that the lawsuit is the beginning of a public battle to enforce parity laws. “Unfortunately, what the plaintiffs complain about—insurer manipulation of nonquantitative treatment limitations, CPT code changes, provider reimbursement rates, and documentation requirements in order to deprive mental health patients of the benefits for which they have paid—is not unique to United or to New York,” she told Psychiatric News. APA has been working with psychiatric patients, attorneys and members on these issues and on this case and others that have been filed and will be filed in the near future in an effort to compel carriers to stop what we believe are flagrant violations of the law and abuse of mental health patients and psychiatrists.” ■

The class action complaint is posted at http://www.psych-appeal.org/img/Complaint.pdf.

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