Mental health parity victory in Vermont

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News Release from the American Psychiatric Association

One Step Forward On Mental Health Parity

ARLINGTON, Va. (May 1, 2013) — Yesterday, the United States District Court for the District of Vermont became the first court in the country to interpret the Mental Health Parity and Addiction Equity Act of 2008—and that decision is favorable to mental health patients.

In C. M. v. Fletcher Allen Health Care, Inc., plaintiff C. M. challenges her health plan’s administration of mental health benefits. Specifically, she alleges that the Plan violates MHPAEA by: (1) requiring pre-­‐ approval for routine mental health services but not for medical-­‐surgical services; (2) conducting concurrent reviews of mental health services but not requiring such reviews for medical-­‐surgical services; and (3) initiating automatic review processes triggered by a fixed number of visits for mental health services but not for medical-­‐surgical services.

The defendant argued that the Interim Final Regulations under MHPEA require that, in addition to demonstrating that mental health services were treated in a different manner than medical-­‐surgical services, patients have to demonstrate that “no clinically appropriate standard of care would permit a difference,” to prove violation of MHPAEA. The Court disagreed, finding that “the Parity Act was promulgated to eliminate impermissible disparity in the benefits afforded for mental health and substance abuse disorders when compared to those afforded medical/surgical conditions. ...  It stands to reason that plan administrators would also bear the burden of establishing under the Parity Act, why mental health and medical benefits are treated differently based upon divergent clinical standards.”

According to Colleen Coyle, General Counsel of the American Psychiatric Association, “this is significant because it clearly puts the burden on the insurance industry to provide clinically appropriate standards of care to justify treating mental health claims differently than medical-­‐surgical claims. Mental health and substance disorder patients have a right to know whether they are being treated differently than patients with other physical or surgical issues, and if so, on what clinical grounds the insurance companies justify that difference.”  The APA assisted the plaintiff’s counsel in briefing the MHPAEA arguments in this case, has filed another lawsuit against insurers Anthem and WellPoint, and is in the process of challenging several other insurance carriers it believes are violating mental health parity.

Lead attorney representing C.M., Alison J. Bell, partner at Langrock Sperry & Wool, LLP said, “Mental health parity is an important lifeline for my client, who was denied benefits for medical care desperately needed in order to live a healthy life.  We are grateful for the APA’s assistance with MHPAEA issues.” Meiram Bendat, founder of Psych-­‐Appeal, which assists mental health professionals and their patients in challenging insurance denials for mental health treatment, added “Psych-­‐Appeal has worked hard to bring the parity issues to the forefront in this case and proudly hails its collaboration with plaintiff's counsel and the American Psychiatric Association."

Last weekend, former Congressman Patrick Kennedy held a round table discussion with psychiatrists, patients, mental health advocates, and political leaders about mental health parity, and the need for patients to speak out publicly about disparate treatment of mental health claims in order to ensure that the full vision of MHPAEA is realized. (Read one of the patient stories as previously provided in hearings held by the Connecticut Health Care Advocate’s office.)  James Scully, CEO and Medical Director of the APA stated, “The APA applauds plaintiff C.M. and others who spoke at the round table last week for having the courage to stand up for the right to care. We look forward to the day when parity is fully realized and those with a mental illness and/or substance use disorders can expend their energy and resources conquering the illness, rather than battling the insurance companies for the coverage to which they are entitled and for which they and their employer have paid.”

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.

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