A federal court ruling in Northern California against the nation’s leading health insurance provider shines a light on the power of stigma against addiction, and how it can often prevent patients from getting the care they need. Wit v. UBH found that United Behavioral Health rejected the insurance claims of tens of thousands of people seeking mental health and substance use disorder treatment based on defective medical review criteria. Treatment and recovery advocates are saying the ruling is a victory for those suffering addiction and mental health conditions that have found themselves frozen out of the treatment process and denied insurance.
What Are the Facts?
Natasha Wit sought coverage for multiple conditions, including depression, anxiety, obsessive-compulsive behaviors, a severe eating disorder, and related medical complications. When she was turned down, her family ended up paying over $30,000 out of pocket even though she was technically covered. After discovering that over 50,000 more patients received similar denials of insurance, Wit and 10 other plaintiffs filed suit on their behalf. Ultimately, it was ruled that UBH’s internally developed guidelines, specifically its level of care guidelines and coverage determination guidelines, were “unreasonable and an abuse of discretion” and “infected” by financial incentives.
What Does This Mean Going Forward?
Beyond the immediate vindication of tens of thousands of worthy applicants who were hastily and illegally turned down or insurance coverage, the ruling shines a much-needed light on the full breadth of stigma toward addiction and how it can even affect institutional access to treatment. The judge in the case voiced specific concerns that UBH was in violation of the 2008 Mental Health Parity Act. A full summary of the case, and what it means going forward, was written by former senators Patrick Kennedy (D- Rhode Island) and Jim Ramstad (R-Minnesota), both of whom have been fierce advocates for increased access to healthcare for Americans struggling with addiction and mental illness.