Attorney General James and US Department of Labor Offer $ 14 Million to Consumers Denied by Mental Health Coverage

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UnitedHealthcare illegally denied coverage to 20,000 New Yorkers
for mental health and addiction treatment

NEW YORK – New York Attorney General Letitia James and the United States Department of Labor (USDOL) today announced landmark agreements with UnitedHealthcare (United), the country’s largest health insurer, to resolve allegations according to which United have illegally denied health care coverage for mental health and substance use. treatment of disorders for thousands of Americans. As a result of the deals, United will pay approximately $ 14.3 million in compensation to consumers affected by the policies, including $ 9 million to more than 20,000 New Yorkers with behavioral health issues who have received refusals or reductions in reimbursement. New York law and federal law require health insurance plans to cover treatment for mental health and substance abuse disorders in the same way that they cover physical health treatment. The agreements – which resolve investigations and disputes – deal with United’s policies that illegally restricted coverage of outpatient psychotherapy, hampering access to these vital services for the hundreds of thousands of New Yorkers for whom United administers health benefits. behavioral health. In addition to paying affected consumers, United will remove the barriers it has imposed and pay more than $ 2 million in penalties, of which $ 1.3 million will go to New York State.

“In the shadow of the most devastating year for overdose deaths and in the face of growing mental health challenges from the pandemic, access to this care is more critical than ever,” said Attorney General James. “United’s denial of these vital services was both illegal and dangerous – putting millions of people at risk during the darkest times. There must be no obstacles for New Yorkers seeking health care of any kind, which is why I will always fight to protect and develop it. I thank Secretary Walsh for his partnership on this important issue.

“Protecting access to treatment for mental health and substance abuse disorders is a priority for the Ministry of Labor and something that I strongly believe in as a person in long-term recovery,” said US Secretary of Labor Marty Walsh. “This settlement provides compensation for many people who have been denied all benefits and fair treatment. We appreciate Attorney General James and his office for their partnership in investigating, identifying and remedying these violations. ”

New York’s Behavioral Health Parity Act – originally enacted as “Timothy’s Law” in 2006 – and Federal Mental Health Parity and Addiction Equity Act 2008 (MHPAEA) require that insurance coverage for the treatment of mental health and substance abuse disorders be no more restrictive than insurance. coverage of physical health problems. The agreements are the product of the first joint state-federal application of these laws.

The Attorney General’s Office (OAG) complaint – which parallels the USDOL complaint – has been filed with the U.S. District Court for the Eastern District of New York, with the agreements. Each complaint describes two United practices that the agencies say violated parity behavioral health laws through discriminatory practices that unduly restricted psychotherapy coverage:

1) Refund penalty

United has penalized thousands of New York members by charging them more than they should for psychotherapy with non-doctors, who are the main providers of this service. United did so by reducing the authorized amount – which determines reimbursement – by 25% for services provided by doctoral-level psychologists and 35% for master-level therapists. It violated parity laws because United applied these reductions to psychotherapy at all levels, but for medical treatment it only applied similar restrictions in limited circumstances.

2) Algorithms program for efficient reporting and processing (ALERT)

United used arbitrary cutoffs to trigger a review of psychotherapy use, which often led to denials of coverage when providers could not justify continuing treatment after 20 sessions. Members who received these denials had to choose between figuring out how to pay hundreds, if not thousands of dollars for continuing care, and abruptly ending the treatment needed. United has rejected thousands of psychotherapy requests from New Yorkers under ALERT, even during the COVID-19 pandemic. These denials violated parity laws because United subjected all outpatient behavioral psychotherapies to outlier management, but only used this treatment limitation in a handful of medical / surgical departments.

United’s illegal and discriminatory practices have hampered access to behavioral health services for over half a million New Yorkers with fully insured United health plans and many more with self-insured private health plans administered by the company.

Under the agreements, United will cease applying the refund penalty and will not apply a similar new policy in New York for at least two years. United will also stop applying the ALERT program – and stop issuing denials – for psychotherapy in New York City, and will not implement a new outlier management program until at least 2023.

This case is being handled by Deputy Attorney General Michael D. Reisman of the Office of Health Care, who is overseen by Deputy Chief of Office Leslieann Cachola. The Office of Health Care is part of the Social Justice Division, which is headed by Chief Deputy Attorney General Meghan Faux and overseen by Senior Deputy Attorney General Jennifer Levy.

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