Wrong decision jeopardizes mental health coverage for millions of CT scan patients

At a time when more than 28% of Connecticut adults are reporting symptoms of anxiety or depression — up from 19% two years earlier — the nation’s largest insurer is threatening to impede access to much-needed mental health care.

This decision in the Case of Wit v. United Behavioral Health (UBH) encourages insurers to choose coverage for acute treatment rather than determining coverage based on generally accepted standards of care, further depriving individuals of access to the long-term care they need.

Our state and our nation are going through a severe mental health crisis, further exacerbated by the pandemic, which has driven individuals to seek treatment in record numbers. At Mental Health Connecticut (MHC), we advocate and educate Connecticut residents and their communities about the importance of mental health, connect individuals to support services, and provide communities with the tools they need to care for their relatives.

In our work, we frequently encounter people who struggle to access the mental health care they need. We hear story after story of people being denied care because their insurers determine medical necessity by their own standards, rather than evidence-based standards developed by medical professionals. This dynamic further impedes access to mental health care within a system that is difficult to navigate for many other reasons.

A March 5, 2019 court ruling found that United Behavioral Health violated the Mental Health Parity and Addictions Equity Act of 2008 (MHPAEA). This federal parity law requires equal treatment by insurance companies of people with mental illnesses and addictions. However, in March 2022, a three-judge panel of the 9th Circuit Court of Appeals overturned the district court’s order with a seven-page decision, arguing that it is “not unreasonable” for insurers to determine coverage inconsistently with generally accepted standards of concern.

The disconnect between the robust and comprehensive 100-page plus district court ruling and the superficial 7-page reversal in Wit v. United Behavioral Health is ineligible. The current ruling will encourage insurers to make decisions that are out of step with clinical standards. The ripple effects of this case will be felt not just in Connecticut, but across the country.

In May, Connecticut was one of four states (along with Rhode Island, Illinois and California) that filed amicus briefs seeking the reversal of this reversal. Leading the charge in Connecticut is Attorney General William Tong, who said, “It makes no sense, in the face of America’s worst public health crisis, for insurance companies to prioritize profits over people and impede treatment and prevention”.

In March of this year, MHC joined 12 other Connecticut-based organizations in a letter supporting Attorney General Tong’s amicus brief. MHC and our allies are grateful for the support of AG Tong and look forward to raising awareness of the devastating consequences of the current Wit decision.

The current Wit decision contrasts with Mental Health Connecticut’s mission and further complicates the work of our partner network. Connecticut residents deserve consistent, reliable access to the care they need to thrive and heal — and insurance coverage should be the last of their barriers to seeking services to feel healthy and well.

The real implications of Wit v. UBH affects far more than the 50,000 plaintiffs and thousands of Connecticut residents with mental health issues. The current Wit decision sets a national precedent that insurers, rather than medical experts, can dictate the level of care to be covered for mental health patients.

We implore the Ninth Circuit Board of Appeals to uphold patients’ right to access safe and consistent care and grant en banc review of this case.

Luis Perez is President and CEO of Mental Health Connecticut.

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