The importance of accessible quality behavioral health services is gaining increased attention among millennials, Gen Z, and healthcare professionals. But historically, behavioral health has been considered less important than physical health, meaning it has also received less funding and support.
Recognizing the need for change, the federal government passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (the Parity Act), which mandates that behavioral and physical healthcare be treated equally.
In practice, this requires insurance companies to amend coverage guidelines, which traditionally focused on physical health, to more fully include behavioral health. Recent cases are helping put the ideals of the Parity Act into practice by ruling against parties who continue to treat behavioral health and physical health disparately.
Last year, the Ninth Circuit clarified the full extent of “parity” in Danny P. v. Catholic Health Initiatives, 891 F.3d 1155 (9th Cir. 2018). In March 2019, the U.S. District Court in the Northern District of California added fuel to the flame in its 106-page ruling of the class action case Wit v. United Behavioral Health (UBH), which underscores the dangers of sacrificing quality behavioral healthcare for an insurance company’s financial gain.
In Wit v. UBH, the plaintiffs asserted two claims against UBH under the Employee Retirement Income Security Act of 1974 (ERISA): breach of fiduciary duty and arbitrary and capricious denial of benefits.
Because the insurance plans at issue were ERISA-governed health benefit plans, they were subject to federal laws, including the Parity Act. The plaintiffs argued that UBH's Level of Care Guidelines and Coverage Determination Guidelines were fundamentally flawed because they fell short of the generally accepted behavioral health standards of care and based coverage decisions on financial concerns rather than on best practices.
The court agreed.
The court ruled the guidelines were tainted by UBH’s financial department, which were significantly involved in their development. Additionally, the court ruled that the evidence showed the guidelines were used to mitigate the impact of the Parity Act.
Page 2: Evidence-based standards of care for behavioral health