Mental Health Parity and the Wit v. UBH Class Action Lawsuit

Austen Riggs Medical Director/CEO (2018-2024) Eric M. Plakun, MD, comments on the latest developments in the Wit v. United Behavioral Health (UBH) case and remarks on the Biden administration’s latest efforts to enforce mental health parity.

"The ninth Circuit 3-judge appellate panel in Wit has revised its previous ruling that reversed much of the verdict. The panel’s revised decision properly recognizes that UBH guidelines failed to meet generally accepted standards of care for access to residential, IOP, and outpatient services, and that coverage of these was part of the plans. This is an important step forward in access to care, but the fight is not over."

“Appeals Court Revitalizes Mental Health Claims Case Wit v. United Behavioral Health” (Behavioral Health Business, August 24, 2023)

"Kudos to the Biden administration for holding insurance companies accountable for demonstrating that they have achieved mental health parity. Parity is real when insurance entities have adequate networks of providers to offer treatment–and that treatment must meet the generally accepted standard of pursuing the goal of recovery, not mere crisis stabilization."

“Federal Agency Declares It is ‘Dead Set’ on Enforcing Parity” (Psychiatric News, August 28, 2023)

“The Biden administration proposes new rules to push insurers to boost mental health coverage” (Associated Press, July 25, 2023)

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. Plakun is an authority on access to care, implementation of mental health parity, and other advocacy issues.

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.

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

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.

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.

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.

The National Council for Behavioral Health has developed a new toolkit to empower behavioral health providers to claim their role as an authority on generally accepted standards of care.

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