In March, a federal appeals court overturned a landmark ruling against a UnitedHealth subsidiary over behavioral health care denials.
Now, the plaintiffs in that class-action suit are pushing for an en banc review of the 9th Circuit Court of Appeals' decision, attorneys at Zuckerman Spaeder, which represents 60,000 plaintiffs, said Friday. They are joined in the push by other co-counsel.
A federal district court ruled in 2019 that United Behavioral Health committed "pervasive and long-standing violations" of the Employee Retirement Income Security Act (ERISA) by rejecting thousands of claims for behavioral health needs in a bid to protect its bottom line. The court ordered UBH to reprocess all of the claims at the center of the suit and overhaul its protocols for processing claims.
Mental health parity advocates hailed the decision as a watershed moment for mental health parity.
“If allowed to stand, the Ninth Circuit’s ruling will reverse years of legal progress towards mental health parity and be devastating for millions of Americans seeking mental health and addiction treatment,” said Zuckerman Spaeder Partner Caroline E. Reynolds in a statement.
“It will encourage UBH and every other insurer to treat the terms of American workers’ health plans as mere suggestions that can be overridden at the insurer’s whim. As this and other cases have already proven, that means coverage decisions will end up being driven by accountants rather than medical professionals," Reynolds said.
However, the 9th Circuit argued that the company had followed plan terms in issuing the denials. UBH is not required to cover all services as long as its denials follow generally accepted standards of care.
In its petition, the plaintiffs outline several reasons that they believe make a review crucial. For one, they argue that the ruling "undermines" ERISA in a way that will make it harder for people to access mental health treatment, as it could open the door for insurers to make claims denials that ignore the terms of their plans.
In addition, the 9th Circuit's ruling disregards precedent on conflicts of interest for ERISA plan administrators, the plaintiffs said, by deferring to UBH's guidelines without examining whether they were consistent with the plan terms.
“Beyond the huge societal impact of this ruling, there are unambiguous and compelling legal reasons for a rehearing,” said Zuckerman Spaeder Partner Adam B. Abelson in a statement.