9th Circuit Court rules that plaintiffs failed to make their case on UBH's "inconsistent" medical necessity determinations.
A federal appeals court has dealt a blow to mental healthcare advocates.
The 9th U.S. Circuit Court has overturned a district court ruling that plaintiffs failed to demonstrate that United Behavioral Health made medical necessity determinations for mental health and substance abuse that were inconsistent with generally accepted standards of care.
The plaintiffs in Wit v. United Behavioral Health, led by Legal Action Committee, said they were "disappointed with the ruling, as it will allow insurers to determine whether substance use disorder and mental health treatment services are medically necessary using their own proprietary guidelines - even when they deviate from generally accepted standards of care - and deny services based on the insurer and health plan's financial interests."
LAC said that before the 2019 Wit decision, UBH used guidelines that differed from standards set by the American Society of Addition Medicine, LOCUS, and CALOCUS criteria and denied services to treat often life-threatening emergencies.
"As a result of the Ninth Circuit’s decision, thousands of individuals who were supposed to have their addiction and mental health care claims reprocessed under generally accepted standards of care will now be left without any remedy," LAC attorney Sika Yeboah-Sampong said.
"This ruling is particularly devastating as we see escalating rates of suicide and record-breaking overdose deaths nationwide.” As our country continues to face these crises that are leaving so many without access to life-saving care, we urge the full Ninth Circuit to review this flawed decision."
“As a result of the Ninth Circuit’s decision, thousands of individuals who were supposed to have their addiction and mental health care claims reprocessed under generally accepted standards of care will now be left without any remedy.”
Sika Yeboah-Sampong, Legal Action Committee
John Commins is the news editor for HealthLeaders.
KEY TAKEAWAYS
The plaintiffs in Wit v. United Behavioral Health said they were "disappointed with the ruling, as it will allow insurers to determine whether substance use disorder and mental health treatment services are medically necessary using their own proprietary guidelines.
Before the 2019 Wit decision from a federal district judge, plaintiffs alleged that UBH used guidelines that differed from standards set by the American Society of Addition Medicine, LOCUS, and CALOCUS criteria and denied services to treat often life-threatening emergencies.