Fighting for those who suffer from mental health and substance use issues

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Mental health care remains one of the most important social issues of our time—a fact reflected in Congress’ passage in 2008 of the Mental Health Parity and Addiction Equity Act (“Parity Act”), and statistics showing that nearly 50 percent of adults will experience a mental illness in their lifetime, many with moderate to severe symptoms. The Parity Act, and similar state laws, require insurance companies that provide mental and substance abuse health care to do so “at parity” with medical and surgical benefits. 

Zuckerman Spaeder, led by partners D. Brian Hufford and Jason Cowart, launched a focused effort to fix one of the primary reasons for this stunning lack of mental and substance abuse treatment: the insurance industry’s widespread efforts to limit or deny behavioral health benefits.

National scope and national attention

Recognizing that insurers have, for years, developed a variety of policies and procedures that limit behavioral health coverage, Zuckerman Spaeder is leading a national legal effort to systematically challenge those practices. In doing so, the firm is fighting for those who struggle with serious mental health conditions and life-threatening addictions, those who are close to them, and those who treat their conditions. 

This work led to a precedent-setting class certification decision in 2016, which opened the door to a series of significant wins in 2017. These decisions have given new hope to millions of patients who have faced unfair and illegal mental and substance abuse health claim denials. It has also gained high profile support, including from the U.S. Department of Labor and former U.S. Rep. Patrick Kennedy. 

Class certification sets the stage 

On September 19, 2016, the U.S. District Court for the Northern District of California certified classes of plaintiffs in two companion lawsuits against United Behavioral Health—a subsidiary of UnitedHealth and the largest managed behavioral health care organization in the United States. The certifications in Wit et al. v. UnitedHealthcare et al. and Alexander et al. v. United Behavioral Health were the first classes to be certified in a lawsuit against an insurer challenging its mental health coverage guidelines and seeking revision of those guidelines and reprocessing of previously denied claims. The trial took place in October 2017; a decision is pending.

The class certification decision, and subsequent trial, represented a tremendous step forward in the fight for proper coverage for behavioral health services. It affirmed the plaintiff’s belief that health insurers can be held responsible, on a class-wide basis, for their denials. It was particularly important because few (if any) patients have the resources necessary to individually challenge this type of industry-wide misconduct.

Growing momentum

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In April 2017, the U.S. District Court for the Central District of California both certified a class of behavioral health patients and granted preliminary approval of a settlement in a lawsuit brought by the firm in Weil v. Cigna, et al., in which we alleged that Cigna improperly denied coverage for Transcranial Magnetic Stimulation (TMS) therapy as a treatment for Major Depressive Disorder, asserting that it was “experimental and investigational.” Plaintiffs alleged that this policy violated Cigna’s fiduciary obligations ERISA. In August 2017, the court granted final approval of the settlement, pursuant to which Cigna agreed to cover TMS services moving forward and created a monetary fund to compensation class members whose claims were previously denied. 

A month later, in May 2017, the U.S. District Court of the District of Connecticut certified a similar class of plaintiffs in Meidl v. Aetna Inc., et al., in which the firm alleged that Aetna, like Cigna, had refused to cover TMS services based on an “experimental and investigational” exclusion. In certifying the class, the court cited with approval both the Wit and Weil decisions, demonstrating how the firm’s cases are reinforcing the development of the law. 

Just one month after that, the firm achieved another significant win in Charles Des Roches, et al. v. California Physicians’ Service, et al., where yet another class was certified in a lawsuit against Blue Shield of California and Human Affairs International of California, Inc., a subsidiary of Magellan Health, Inc., pending before the U.S. District Court for the Northern District of California. The ruling, which cited both the Wit and Meidl decisions, is further affirmation that Zuckerman Spaeder’s efforts have enhanced the ability of insureds to challenge mental health denials on a collective basis.
    
The firm has further extended his campaign for mental health coverage and parity through new lawsuits. In March 2017, Zuckerman Spaeder filed a class-action complaint in the U.S. District Court for the Eastern District of New York, alleging that UnitedHealth and its Oxford subsidiaries have systematically violated the Parity Act by denying coverage for nutritional counseling for patients suffering from eating disorders, despite the fact that the defendants cover such treatment for patients with medical conditions, such as diabetes.

The firm has further extended his campaign for mental health coverage and parity through new lawsuits. In March 2017, Zuckerman Spaeder filed a class-action complaint in the U.S. District Court for the Eastern District of New York, alleging that UnitedHealth and its Oxford subsidiaries have systematically violated the Parity Act by denying coverage for nutritional counseling for patients suffering from eating disorders, despite the fact that the defendants cover such treatment for patients with medical conditions, such as diabetes. 

Then, in July 2017, the firm sued UnitedHealth again for Parity Act violations, this time in the U.S. District Court for the Eastern District of New York. In that action, the firm alleges that UnitedHealth imposed arbitrary reimbursement penalties on psychotherapy through the use of a policy that reduces the “allowed amount” of covered charges by 25 percent when provided by a psychologist and 35 percent when provided by licensed social works. As a result, anyone receiving psychotherapy services from a psychologist or social worker is subject to reduced reimbursements. 

A new hope

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These victories, along with the potential for a favorable outcome in the Wit case, demonstrate that it is possible to address the way insurers’ handle mental health and substance addiction claims. 

The firm’s work is offering new hope for patients with severe behavioral health issues, for whom access to treatment can be a life-or-death issue.