Health Advocates Urge Court to Enforce Insurer’s Promise of Behavioral Health Care in Amicus Brief

On Friday, the National Health Law Program (NHeLP) and the Harvard Center for Health Law and Policy Innovation (CHLPI) submitted an amicus brief on behalf of 38 organizations supporting the Plaintiff-Appellants’ Request for En Banc Review by the Ninth Circuit in Wit v. United Behavioral Health.

This case was brought by a class of people with insurance administered by United Behavioral Health. The district court held that United Behavioral Health (UBH) violated the class members’ rights by using medical necessity criteria for services that were not consistent with generally accepted standards of care. Generally accepted standards of care are agreed upon standards for treatment among clinicians that are reflected by non-profit clinical professional associations such as the American Society of Addiction Medicine. The UBH plan contracts in the case had all promised to approve covered services consistent with generally accepted standards of care. The district court found that UBH illegally used internal and improper medical necessity criteria to deny behavioral health care that was promised to the class, and ordered UBH to reprocess claims for the class, among other remedies. This decision reflected the importance of insurers providing the care promised by the plan, including the medically necessary behavioral health services.

NHeLP and CHLPI previously submitted a brief on behalf of 28 amici asking the Ninth Circuit Panel to affirm the district court’s decision. Unfortunately, in March the Ninth Circuit Panel reversed the District Court, finding that UBH could use its own criteria to deny covered benefits regardless of whether generally accepted standards indicated they should be provided.

Both NHeLP and CHLPI’s previous brief and the one filed on Friday, emphasized the importance of the underlying behavioral health services. NHeLP and CHLPI noted that millions of people in the U.S. need mental health and substance use disorder services, collectively known as behavioral health, but do not get them. Despite the high numbers of people who need behavioral health care, people often have trouble accessing the care they need.

NHeLP Senior Attorney Elizabeth Edwards explained the importance of the amicus brief: “The impact of not receiving such care, especially when insurers focus largely on acute rather than chronic behavioral health care, is grave, leading to preventable crisis care, institutionalization, and worse.”

NHeLP Senior Attorney Abbi Coursolle added, “Not only do insurance practices to deny behavioral health care lead to worse patient outcomes, they also shift costs to families, employers, and governments.”

Kevin Costello, Litigation Director of the Center for Health Law & Policy Innovation of Harvard Law School echoed these concerns. “If left undisturbed, the Ninth Circuit’s decision has the potential to license improper health insurance policies and practices that deny access to basic mental health treatment with criteria that are untethered from the generally accepted standard of care.  This would be a significant blow to consumers nationwide seeking to enforce their health care rights.”

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The full list of amici:

National Health Law Program

Center for Health Law & Policy Innovation

2020 Mom

Alabama Disabilities Advocacy Program

American Foundation for Suicide Prevention

American Lung Association

Assistive Technology Law Center

Autism Legal Resource Center LLC

Bazelon Center for Mental Health Law

Center for Public Representation

Charlotte Center for Legal Advocacy

Community Service Society of New York

Depression and Bipolar Support Alliance

Disability Rights California

Disability Rights Education and Defense Fund (DREDF)

Disability Rights New Jersey

Families USA

Florida Health Justice Project

Health Law Advocates

Inseparable

Legal Action Center

Mental Health Advocacy Services

Mental Health America

National Alliance on Mental Illness (NAMI)

National Autism Law Center

National Center for Law and Economic Justice

National Disability Rights Network

National Women’s Law Center

Northwest Health Law Advocates

Partnership to End Addiction

Public Justice Center

Recovery Advocacy Project

The Arizona Center for Law in the Public Interest

The Kennedy Forum

The Trevor Project

United States Society for Augmentative & Alternative Communication

Well Being Trust

William E. Morris Institute for Justice