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Arbitrary limits on psychotherapy sessions for mental health patients has put UnitedHealth Group on the defensive. The New York State Psychiatric Association (NYSPA) and three individual plaintiffs have filed a class action lawsuit against the insurer for allegedly violating the Mental Health Parity and Addiction Equity Act by refusing to pay for necessary treatment for patients facing serious mental health issues, second guessing the recommendations of therapists actually involved in the treatment of those suffering from mental illness.

Michael Kamins joined the lawsuit after the psychiatrist treating his son’s bipolar disorder recommended two psychotherapy sessions per week. After a period of covering the twice-weekly sessions, Kamins insurer, UnitedHealth Group, suddenly decided it would cover only two sessions per month. This was unacceptable second-guessing of a doctor’s recommendations for Kamins; his son’s mental illness had previously led to suicide attempts and he was not willing to watch the backslide that would come with limited treatment

The parity law requires doesn’t require insurers to offer coverage of treatment for mental health issues, but if it does, an insurer is required to treat coverage decisions the same as it does for medical or surgical coverage.

The lawsuit alleges that insurance coverage was wrongfully denied or that additional hoops were established to obtain approval for mental health patients. The facts asserted claim that:

  • UnitedHealth Group required overly-restrictive pre-approvals for talk therapy
  • UnitedHealth Group wrongfully denied coverage of an extended hospital stay for a mentally ill teen, claiming that outpatient options should have first been exhausted, despite the teen living more than 100 miles from the nearest treatment facility

Some question whether these types of lawsuits will be beneficial to those with mental health issues or if they will end with insurers simply becoming more restrictive in approving medical coverage. So far, there has been no indication that that will happen. Large insurers have continued to offer mental health and substance abuse treatment as part of their policies.

Source: KERO, “Class-action suit tests mental-health coverage rules,” April 12, 2013

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