Austen Riggs Center

Original publication: November, 5, 2020

On February 28, 2019, Judge Joseph Spero of the United States District Court for the Northern District of California issued the findings of fact and conclusions of law in Wit v United Behavioral Health (UBH), a class action brought against the country’s largest behavioral health insurer. On November 3, 2020, Judge Spero issue a ruling related to the remedy phase of this case. Based on his knowledge and experience, Austen Riggs Center Medical Director/CEO Eric M. Plakun, MD, served as plaintiffs’ expert on adult mental disorders for this case. Dr. Plakun is an authority on access to care, implementation of mental health parity, and other advocacy issues.  

Articles about Judge Joseph Spero’s November 3, 2020 Ruling  

Background and Resources  

Medical Necessity Letters: Tips and Templates to Help Your Patients with Insurance Coverage for Mental Health Treatment

13 years after Congress passed the Mental Health Parity and Addiction Equity Act, psychiatric professionals and patients still wrangle with insurance providers to pay for medically necessary—and legally mandated—coverage.  Writing in the Journal of Psychiatric Practice, four authors with medical, legal, public-policy, and personal experience in this area provide expert advice as well as letter templates and suggested text that you can access and download for FREE.  

Taming the Wild West of Managed Care | The Dorm and Austen Riggs Center - YouTube

Insurance companies regularly deny access to mental health treatment that you determine to be medically necessary for your patients. In this presentation, Eric Plakun, MD explores the “game-changing” impact that the verdict in the Wit v. United Behavioral Health class action suit can have on access to care and insurance coverage for your patients.

New APA-Backed Federal Parity Law Is a Game Changer

APA-backed federal legislation enacted in December 2020 gave the federal government powerful new authority to enforce the law that requires insurers to provide the same access to psychiatric treatment as other medical care for patients they cover. For anyone who’s struggled to find psychiatric care, or has found it too expensive to afford, this law, strengthening mental health parity, is a game changer. Learn more at psychiatry.org/parity

Wit v. United Behavioral Health: How This Landmark Verdict Puts Mental Disorder Access to Care Standards Back In Your Hands

In November 2020, a federal magistrate judge issued a stinging rebuke to the United Behavioral Health division of UnitedHealth Group, the nation's largest behavioral health insurer, saying it could no longer use its overly restrictive guidelines to deny mental health and substance use treatment and compelled them to reprocess over 50,000 claims. In this webinar, three experts with intimate knowledge of the case, Meiram Bendat, Joe Parks, and Eric Plakun, discuss how the ruling curbs the power of insurance companies to decide what standards of care are appropriate, and provide insights on how caregivers can use the verdict to advance access to care for their patients. 

Wit v. UBH: What it Means to You

In this video, Austen Riggs Medical Director and CEO Eric M. Plakun, MD, who served as plaintiffs’ expert in Wit v. United Behavioral Health, details how the order hands clinicians and professional groups a powerful tool to reclaim their role in determining access to care for patients.   

Freedom of Access to Medically Necessary Treatment 

As clinicians know, and as Federal District Court Judge Joseph Spero made part of his verdict in the landmark Wit v. UBH  class action lawsuit [which we reference later in this piece], treatment should address underlying problems and co-occurring disorders in a way that goes well beyond mere crisis stabilization. 

Lessons from the Legal Trenches  

Caroline E. Reynolds, Esq., explains the theory of the case, in which UBH (Optum), the nation’s largest behavioral health claims administrator, was found liable for breaching its fiduciary duties to its insureds by developing and using medical necessity criteria that were pervasively more restrictive than generally accepted standards of care. 

WEBINAR: Upholding Generally Accepted Standards of Care: Strategies Informed by the Wit Case 

Dr. Plakun’s 4 Tools to Maximize Insurance Claim Appeal Success 

If you receive a denial from your insurance company for mental health treatment that you and your treating clinician believe is medically necessary, there are four important tools to maximize the chances for success in an appeal.