The court’s ruling will allow a suit brought by the New York State Psychiatric Association (NYSPA) against United to go forward in the U.S. District Court for the Southern District of New York. 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 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 (as United argued) to recover benefits.
APA President Renée Binder, M.D., commented, “Today’s decision gives professional organizations, such as APA and NYSPA, the right, on behalf of its members and their patients, to sue for mental health parity violations, which is important because patients are often unable to speak out for themselves. This ruling gives us hope that the Mental Health Parity Act of 2008 will now be enforced.”>
Seth Stein, J.D., executive director of NYSPA, hailed the court’s decision as a victory for NYSPA members and their patients. “NYSPA pursued this lawsuit to help enforce federal parity rules," he told Psychiatric News. “We are pleased that the court agreed that NYSPA had standing at this point in the litigation to represent the interests of our members and their patients, particularly where we believe that health plans are violating federal parity laws and interfering with access to care for the treatment of mental illness. The decision of the court regarding the ability to sue plan administrators is particularly important because it removes a technicality that plan administrators might raise to avoid being responsible when they make determinations that run afoul of federal parity laws.”
The original lawsuit was brought by NYSPA and several individual patients, a member psychiatrist, and a psychologist in March 2013 alleging that UnitedHealth Group and subsidiaries, including United Behavioral Health, systematically violated the federal parity law and the Affordable Care Act. NYSPA joined the suit on behalf of its members and their patients. At that time, Stein told Psychiatric News that the district branch had fielded numerous complaints from its members about denial of mental health and substance use treatment by United (Psychiatric News, April 5, 2013).
In his blog on APA's website, APA Medical Director and CEO Saul Levin, M.D., M.P.A., wrote, "APA is working tirelessly to advance parity. ... We’ve brought greater attention to parity at the U.S. Department of Labor, to state attorneys general, and to major employers – and we are finding many people are interested to help." Read the entire message.