By  Alan M. Solomon, Ph.D.

A “landmark” settlement with United Healthcare in the state of New York requires UHC to pay $14.3 million to consumers nationwide. This was the first ever joint lawsuit filed by a state (New York) and the federal government. The impacted consumers were either denied coverage or given reduced benefits for mental health and substance use disorders  (https://www.law.com/newyorklawjournal/2021/08/17/in-first-joint-state-fed-enforcement-of-mental-health-insurance-coverage-parity-laws-ag-james-announces-14-3m-settlement/?slreturn=20210724125306 ). Please see previous blogs on this website about this issue (Kaiser Continues to Restrict Access to Counseling;  New Guidelines for Parity of Care;  Unnecessary – and sometimes tragic – Suffering When Therapy is Needed).

Parity laws at both the state and federal level basically require that coverage for mental health or substance use issues be no more restrictive than coverage for physical health issues.  California has its own parity law, which is consistent with the federal legislation.

In addition to $9 million directly paid to New York residents who received denials of coverage or reduction in reimbursement for these services, UHC will remove internal policies that had created these disparities between mental health and physical health coverage. These restrictions of coverage had been in place since 2013 in some instances.

There were two methods by which UHC restricted out-of-network benefits for psychotherapy:

  • The reimbursement for out-of-network was reduced by 25% for Ph.D. psychologists, and 35% for master’s level therapists. This increases the out-of-pocket costs for the client.  These reductions were applied in all instances, compared to only limited circumstances for medical services.
  • UHC would demand frequent review of therapy, which often lead to denial of therapy beyond 20 sessions, and at the least, would discourage therapists from extending needed therapy because of the burden placed on therapists. Such reviews were rare and limited in medical services.

As Letitia James, the NY State Attorney General, said:  “In the shadow of the most devastating year for overdose deaths and in the face of growing mental health concerns due to the pandemic, access to this care is more critical than ever before. United’s denial of these vital services was both unlawful and dangerous – putting millions in harm’s way during the darkest of times.”

A savvy consumer with United Healthcare insurance can, and should, remind their insurance carrier of this settlement in New York. The same may well be true for other insurance plans as well. Your IPN therapist can help you understand these issues so you can receive the kind of quality care you deserve and that is protected by law.

Dr. Alan M. Solomon is  a clinical psychologist in private practice in Torrance, CA. A member of the Independent Psychotherapy Network, he can be reached at 310  539-2772 or dralanms@gmail.com In-person and telehealth sessions are available.

Copyright 2021 by  Alan M. Solomon, Ph.D.

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