The 9th US Circuit Court of Appeals dismissed the plaintiffs’ appeal in White v. United Behavioral Health rejected.
A three-judge panel released the verdict on January 26. While the appeals court sent the case back to the district court, the move is seen as a blow to equality in behavioral health.
“This decision is heartbreaking,” Marvin Ventrell, CEO of the National Association of Addiction Treatment Providers (NAATP), told Behavioral Health Business. “Access to care is already a crisis in America, largely because insurers fail to cover the disease on par with other diseases, often in violation of the federal parity law.”
UnitedHealth Group Inc. (NYSE: UNH) and its subsidiary, UnitedHealthcare, have not yet responded to a request for comment. The plaintiff’s counsel, Zuckerman Spaeder and Psych-Appeal, have also not yet responded. This story may be updated.
BHB also sought comment from the health insurance industry group America’s Health Insurance Plans (AHIP).
In 2019, a district court in Northern California found that United Behavioral Health violated the Employee Retirement Income Security Act (ERISA) and improperly denied behavioral health claims, and sided with the plaintiffs. In March 2022, the circuit court reversed the district court. Since then, the plaintiffs have asked the circuit court to reconsider.
The case amassed 67,000 claims for about 50,000 enrollees that the plaintiffs say were mishandled.
Behavioral health industry leaders and advocates accuse the insurance industry of not paying fair rates compared to physical health care procedures. For decades, Congress has tried to cobble together laws that prevent health insurers from discriminating against behavioral health care.
The US Department of Labor under the Biden administration is increasingly active in enforcing or developing new standards under existing laws.
The insurance industry groups are expressing frustration with new standards being piled on them when they already lack clarity on how they plan to demonstrate their compliance with existing standards.
Federal legislative solutions to parity remain elusive.
In September 2022, the US House of Representatives passed a bill that allowed health plans to be fined for not complying with parity regulations. However, the bill never progressed past that point.
The recently passed omnibus funding bill added $50 million to help state governments with parity enforcement. It also removed a previous exemption that allowed non-federal government entities to opt out of parity requirements.
Reaction to the verdict
Behavioral health industry advocates said the ruling exacerbates the industry’s access challenge. A crippling shortage of providers in the industry is exacerbated by significant parts of the sector choosing not to accept insurance plan participation because the rates are too low or not worth the administrative burden.
“The court effectively lost any ground that mental health and parity advocates gained from the initial White v. United Behavioral Health decision eroded, denying the argument that the [ERISA] requires consistency with generally accepted standards of care,” Alison Kavanagh, vice president of marketing for behavioral health technology services provider Sunwave Health Inc., said in an email. “And by striking down large portions of the original ruling, the 9th Circuit opens the door to policies and practices that could harm millions and perpetuate our nation’s addiction and mental health crisis.”
Ventrell expressed similar concern about the damage the ruling does to parity efforts and the magnitude of the impact on mental health and addiction treatment patients.
“It will be necessary for our legal experts to assess the soundness of the legal analysis used in this decision and to formulate a strategy moving forward to find ways to protect the many millions of Americans who suffer from this often fatal disease. to treat,” Ventrell said.
