The New York State Psychiatric Association (NYSPA), along with several patients and their families, has challenged UnitedHealth Group’s (also known as United Healthcare) practices in a class action lawsuit filed in March in the New York courts.
The suit, which could take years to be brought to any decision or settlement according to Rachel Fernbach, Esq., associate director of NYSPA, claims that UnitedHealth Group has “systematically implemented unlawful and deceptive practices designed to create the illusion of…fairness…while simultaneously undermining access to treatment for the most vulnerable segment of our society.” The claimants allege violations of both federal and state parity laws in United’s practices.
“United appears to be taking an aggressive stance to ‘manage’ mental health care, resulting in frequent denials or reductions in benefits well below the levels that the treating providers believe to be medically necessary,” says D. Brian Hufford, a partner in the New York law firm that is representing the claimants. “While the parity laws are designed to ensure that appropriate insurance benefits are available for mental health and substance abuse, it appears that United is increasing its aggressive oversight as a means of continuing its pattern of underpaying such benefits.”
One concern raised is a preauthorization requirement United imposed on certain outpatient mental health and substance abuse services, he adds, which would not be similar with care deemed medically necessary such as ongoing treatment for asthma, diabetes or heart conditions.
The lawsuit requests that United abolish the preauthorization requirements and use, instead, a retrospective review of treatment, similar to a medical treatment plan.
The NYSPA decided to participate in the lawsuit after attempting to resolve their concerns directly with UnitedHealth over the course of several years.
“For years, since parity was enacted, we advocated on behalf of members to ensure proper implementation,” says Fernbach. “We have contacted UnitedHealth and were not able to resolve these issues to our satisfaction. Our members have experienced many violations around improper reimbursement procedures.”
UnitedHealth is currently reviewing the complaint and gave a brief comment.
“We are committed to helping people with mental health issues reach long-term recovery,” says Maria Gordon Shydlo, public relations director for UnitedHealthcare. “We continue to review the complaint so will have no further comment at this time.”
The next step will be for United to respond to the lawsuit, probably with a motion to dismiss, which is a standard response in this type of case. After that, it will go on to further documentation and testimonial processes.
By Catherine Robertson Souter