The U.S. Court of Appeals for the Second Circuit ruled in August that a lawsuit brought by the New York State Psychiatric Association (NYSPA) against UnitedHealth Group and subsidiaries, including United Behavioral Health, for violation of the federal parity law can go forward.  The ruling also establishes at least two points that may be important in future claims against insurers.

First, it recognized that NYSPA could represent its members and their patients in pressing a claim under the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) through “associational standing.” (Both APA and the AMA filed amicus briefs on behalf of NYSPA emphasizing that associations have traditionally been permitted to represent their members’ interest in litigation that is consistent with the mission of the association and that physicians are permitted to represent the interest of their patients.) Second, it recognized that United could be sued even when it acted not as the insurer but as the administrator of a self-insured plan. This means that the carriers are at risk under MHPAEA whenever they exercise discretion in the administration of benefits and employees do not have to sue their employer to recover benefits.

This ruling gives hope for improved parity enforcement.

From August 20 Psychiatric News Alert