R.I. AG files second challenge against federal behavioral health insurance ruling

R.I. ATTORNEY GENERAL Peter F. Neronha is leading a multistate effort to challenge a federal ruling that denied health insurance subscribers the right to reprocess claims for behavioral health and substance use disorder treatment. PBN FILE PHOTO/RUPERT WHITELEY

PROVIDENCE R.I. Attorney General Peter F. Neronha is renewing a multistate effort to challenge limits on insurance coverage for behavioral health and substance use disorder treatment, this time joined by attorneys general of 14 other states and Washington, D.C.

In January, a federal court, responding to an amicus brief filed by Neronha and the attorneys general of Connecticut and Illinois in May 2022, found that United Behavioral Health [UBH], the largest managed behavioral health company in the U.S., had defied widely held clinical standards for mental health and substance use disorder in denying coverage to “tens of thousands of subscribers.”

However, the court also ruled, plaintiffs who had been denied behavioral health coverage did not have a right to reprocess their claims.

Now, Neronha and 15 other attorneys general are calling for another full court review of the most recent decision, which they say is based on “significant errors that endanger the delivery of mental health care and substance use disorder services which are required to be provided by law.”

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States such as Rhode Island, Connecticut and Illinois have laws holding that health insurance companies can only limit treatment for substance use disorders under standards set up by the American Society for Addiction Medicine Criteria. Last spring, Neronha’s office argued that the federal court’s ruling was based on UBH’s “own, more restrictive criteria.”

The legal dispute dates back to the 2019 case Wit v. United Behavioral Health, in which the U.S. District Court of Northern California ruled that UBH had wrongfully withheld mental health and addiction treatment. But a May 2022 decision by the U.S. 9th District Circuit Court overturned that decision, prompting the first multistate challenge.

The court’s January decision to deny plaintiffs the right to reprocess their claims “seriously undermines current and future plan beneficiaries’ ability to enforce their rights,” the states wrote in their most recent filing. “Although states can set some standards to protect beneficiaries from harmful insurer interpretations of plan benefits, resource constraints mean that not all violations can be addressed through state action alone.”

Additionally, they said, the federal court’s ruling “may exacerbate the difficulties that many patients face in accessing medically necessary treatment for mental health and substance use disorder services, and thus increase the public health risks and dangers that result from such lack of treatment access.”

This denial of coverage comes as substance use disorder and behavioral health disorders as a whole surge in Rhode Island and around the country: In the Ocean State, annual overdose deaths increased by 108% from 2011 to 2020, the attorney general’s office notes. Additionally, 59% of Rhode Island residents with mild mental illness, and 38.3% of those with severe mental illness, did not receive treatment in 2019, according to the Kaiser Family Foundation.

In response to the coalitions’ filing, United Healthcare spokesperson Maria Gordon Shydlo said the company is “committed to ensuring members have access to mental health care consistent with the terms of their health plans and in compliance with state and federal rules.

“As part of our broader commitment to quality care, we continue to support members with increased access to providers and new ways to quickly get the effective behavioral support they need,” Gordon Shydlo continued.

Neronha is joined by the attorneys general of Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Michigan, Minnesota, New Jersey, New York, Nevada, Oregon, Vermont, Washington and Washington, D.C. in filing the latest amicus brief.

Jacquelyn Voghel is a PBN staff writer. You may reach her at Voghel@PBN.com.

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