WASHINGTON, D.C., May 19, 2021 – The American Psychiatric Association (APA) today filed an amicus brief in the United States Court of Appeals for the Ninth Circuit, in the case Wit v. United Behavioral Health (UBH). Joining the brief were the Southern California Psychiatric Society, Northern California Psychiatric Society, Orange County Psychiatric Society, Central California Psychiatric Society, San Diego Psychiatric Society, American Medical Association and the California Medical Association.
On Feb. 28, 2019, the United States District Court for the Northern District of California decided that UBH, the country’s largest managed behavioral health care organization, violated its fiduciary duty to mental health beneficiaries by making coverage decisions according to guidelines established by UBH and influenced by financial interests rather than according to the accepted standards in the industry, as required by the plans it manages. UBH has appealed the decision to the Ninth Circuit.
The APA’s brief in this case calls on the Court of Appeals to uphold the prior decision, noting that “[d]espite the availability of professionally developed, evidence-based guidelines embodying generally accepted standards of care for mental health and substance use disorders, managed care organizations commonly base coverage decisions on internally developed ‘level of care guidelines’ that are inappropriately restrictive. Such guidelines may lead to denial of coverage for treatment that is recommended by a patient’s physician and even cut off coverage when treatment is already being delivered.” The brief is informed by a 2020 APA Position Statement on Level of Care Criteria for Acute Psychiatric Treatment.
“Standards of care should be based on the best treatment for patients, not the bottom line,” said APA President Vivian Pender, M.D. “Some managed care organizations develop their own coverage guidelines that are overly focused on stabilizing acute symptoms of mental health and substance use disorders, rather than treating the underlying illness. When the injury is physical, insurers treat the underlying disease and not just the symptoms. Discrimination against patients with mental illness must end.”
“Failure to provide appropriate levels of care for treatment of mental illness and substance use disorders leads to relapse, overdose, transmission of infectious diseases, and death,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “APA calls upon courts, legislatures, and insurance commissioners to require insurance companies to deliver the care for which patients and employers have paid based upon evidence-based, objective, and patient-centered guidelines, rather than company profits.”
American Psychiatric Association
The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 37,400 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment. For more information please visit www.psychiatry.org.