Significant ruling against health insurer for denying health care to mental health and addiction patients

Significant ruling against health insurer for denying health care to mental health and addiction patients

April 01, 2019

Significant ruling against health insurer for denying health care to mental health and addiction patients

Mental Health Substance Abuse

Joseph C. Spero, a federal judge in Northern California passed a significant ruling recently against a unit of the giant insurer United Health Group. The renowned health insurer was accused of formulating internal policies that discriminated against patients suffering from substance abuse and mental health disorders, in order to promote savings.

Chief Magistrate Spero mentioned in his ruling that United Behavioral Health had violated its fiduciary duty in accordance with the federal law. The United Behavioral Health is a unit of the United Health Group and is responsible for rendering treatments pertaining to addiction and mental illness in private health plans.

The judge labeled the giant insurer’s guidelines as irrational and an abuse of an individual’s freedom of choice. In his 106-page ruling, the chief magistrate also added that the insurer was found to be driven by financial incentives that restricted access to receiving appropriate health care. During the court proceedings, he dismissed most of the arguments put forth by the lawyer’s from the United Health Group as deceptive and ambiguous.

What did the patients say?

According to the patients, the insurer denied them health care facilities as soon as their condition appeared to be stable. One of the litigants said that her son was struggling with substance abuse, but was compelled to quit a residential treatment facility when the insurance provider denied him insurance coverage.

Speaking about the ruling, Psych-Appeal, the law firm representing the litigants, and attorney, D. Brian Hufford, from Zuckerman Spaeder, another private law firm representing the plaintiff, said that this was a huge win for substance abuse and mental health patients. According to the plaintiffs, who filed a class-action lawsuit against the insurer, despite having coverage of United plans from 2011 to 2017, they were denied care.

In their response, after the ruling, United Behavioral Health stated that they did not fail in offering appropriate care to the patients. Speaking in their defense, the insurer said that they intend to prove during the next phase of this trial, how they provided the policy holders with appropriate care. The final judgement of this case is lined up in the next few months.

Classic example of latest developments in the health insurance sector

Compared to other medical conditions like asthma, diabetes, and multiple sclerosis, this case is a classic example of the latest developments going on in the industry, pertaining to how health insurance companies offer coverage for substance abuse and mental health disorders. Even though the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 is in force, a lot of patients have still complained about the hassles of getting care coverage at a time when they are in a relatively less dangerous phase of the disease.

After the federal parity law refrained insurance companies from placing sharp limits pertaining to behavioral health coverage, they came up with an even more deceptive approach. The companies formulated internal rules that concentrated on offering expensive residential and outpatient care only in situations when the patients were extremely unwell. Once the condition of the patients improved, the insurance companies either denied providing services or reduced them considerably affecting the treatment and care standards of the patient.

How was the ruling received by advocates and law makers?

Advocates and law makers welcomed this ruling, since the insurers would not be able to ignore the standards applicable to other forms of medical care, especially in cases of substance abuse or mental health treatment. Angela Kimball, the national director of public advocacy at the National Alliance on Mental Illness (NAMI), also shared a similar opinion regarding this ruling.

Patrick Kennedy, former Congress member said that such denials of health care are not just limited to United Health Group. Kennedy is rooting for a stronger enforcement of federal and state parity laws. He further added that this ruling validates what they have been advocating for the past 11 years, ever since the law was passed.

Mental health treatment at Invictus Health Group

Mental health disorders and addictions are brain diseases which incapacitate the person grappling with them. If left untreated, both these conditions can lead to severe short- and long-term adverse health consequences. With science backing the treatment for both these conditions, it is now possible for people to seek effective treatment from credible mental health and addiction treatment centers.

Invictus Health Group is known for offering quality care for mental health and substance abuse patients in a favorable setting, to promote long-term healing. The team of professionals at Invictus Health Group is committed towards delivering compassionate and skill-based care by considering the individual needs of each patient. The various inpatient treatment programs for mental health and substance abuse have been designed to provide treatment and therapy for every age group.

If you or a loved one is battling with any kind of mental health disorder or an addiction, feel free to reach out to us at Invictus Health Group. You can directly call our 24/7 mental health treatment helpline 866-548-0190 for more information about our research-backed mental health treatment programs. You can also chat online with a representative from the admissions team to learn more about our treatment modalities as well as about our mental health disorder treatment centers.

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