SACRAMENTO – California Attorney General Rob Bonta filed an amicus brief today in the U.S. Court of Appeals for the Ninth Circuit in support of the plaintiffs-appellees in Wit v. United Behavioral Health (UBH) who were improperly denied coverage for mental health and substance use disorder treatment by UBH. Lack of access to mental healthcare services is a critical issue that puts individuals at a greater risk of unemployment, homelessness, substance abuse, suicide, and incarceration. According to one study, two-thirds of all Californians surveyed said they or a close family member sought mental health services, but were unable to obtain them.
“The importance of access to quality mental healthcare cannot be overstated,” said Attorney General Bonta. “When insurers limit access to this critical care, they leave Californians who need it feeling as if they have no other option than to try to cope alone. COVID-19 has taken not only a physical toll, but has also impacted the mental health of so many, making it even more essential that Californians have access to mental healthcare services early, before symptoms reach a crisis level.”
Attorney General Bonta supports the district court’s findings that UBH breached its fiduciary duty to the plaintiffs when it created and used clinical guidelines for mental healthcare that were inconsistent with the standards of care and arbitrarily denied the plaintiffs’ claims for coverage. In today’s brief, the Attorney General argues:
- Access to mental healthcare in California is inadequate. One in six Californians experience some mental illness, with one in 24 experiencing mental illness so severe it impacts their ability to function in daily life. Only one third of adults with a mental illness reported receiving mental health treatment or counseling, which has caused devastating consequences including an increase in deaths by suicide. In California, over 40 percent of adults with serious mental illness did not receive mental health treatment between 2017 and 2018. Many Californians go without treatment because of costs while insured individuals are often forced to seek out-of-network care for mental healthcare services because their private insurer denies their coverage, claiming lack of medical necessity;
- The district court’s remedial order correctly broadens access to mental healthcare by ensuring health plans do not wrongfully deny medically necessary coverage. When a behavioral health plan administrator like UBH uses clinical criteria that is inconsistent with generally accepted standards of care, there is a risk of denials for lack of medical necessity – even when the treatments sought are actually medically necessary. Affirming the district court’s remedies order, which mandates that UBH’s use of clinical criteria conform to generally accepted standards, will give members of the class action against UBH, Employee Retirement Income Security Act (ERISA) health plan beneficiaries, greater access to sorely needed mental healthcare. As a result, the orders may also establish a new precedent for the 700,000 Californians who are members of an ERISA UBH administered plan and influence other ERISA plans; and
- Reversal of the remedial order would likely harm California. After the passage of the Affordable Care Act and establishment of Covered California health insurance marketplace, many Californians became insured. However, California still expends public resources on individuals with private insurance when their insurers deny them medically necessary mental healthcare. In fact, California spends more on mental health services than any other state, spending $8.3 billion on direct mental health services between 2017 and 2018.
By conforming clinical criteria to generally accepted standards of care, the district court’s orders can help expand access to care for mental health conditions, and allow patients to access mental healthcare services before their symptoms reach crisis levels.
A copy of the amicus brief is available here.