For those suffering from mental health issues, undoubtedly you have also run across insurance issues. Your insurance provider does not approve treatment. Your insurance provider reduces the level of care prematurely. Does not approve certain treatment. And you are kept in the cycle of despair.
Some may question, but what about mental health parity? Wasn't the Mental Health Parity law passed in 2008? And what about the Affordable Care Act?
Yes, they exist. But, in essence what they did was to tell insurance companies, you are now in a football game. You are on one side. Families, patients and doctors are on the other side. Sometimes they play at your home field. Sometimes you play at their field. Ok, go.
With this, parity laws allowed insurance companies to decide the rules for the football game, not have to tell other side what those rules were, they got to appoint their own referees and replay officials, and they got to be the commissioner of the league.
That my be changing. On March 5, 2019, a US Magistrate Judge issued a 106 page ruling in a case involving United Behavioral Healthcare/Optum. This ruling eviscerated UBH and held that UBH insurance guidelines do not comply with the applicable standards of care, were deceptive since they were first run by the finance department in order to keep benefit expenses down. The UBH expert witnesses were deemed not credible. And UBH was found to have violated its duty of good faith to its insureds.
The remedies stage is happening now. I have spoken with the plaintiffs' attorneys on a number of occasions. I set up a meeting with one of the attorneys and some of the most influential people in the eating disorder industry at a recent international conference held in NYC. The plaintiffs' attorneys will probably be asking the court to appoint an independent panel to implement guidelines which do comply with the generally accepted standards of care, to appoint an overseer to enforce those guidelines, the class members whose claims were denied can reassert their claims and the UBH guidelines will be thrown out.
They will also be asking for a pool of funds to be established so that class members can make claim for certain damages. Now, UBH/Optum make a net revenue of about $29 million ... PER HOUR! And yes, you read that correctly. So, you can imagine how large that pool could be.
The game is changing. And the rules of the game are now going to be decided differently.
Here are two articles I have written about the decision:
UBH/Optum Decision
Using the Optum/UBH Decision Now