Decision to limit mental health benefits undermines addiction fight, three AGs say

The United States Court of Appeals James R. Browning building, home of the 9th United States Circuit Court of Appeals, is pictured in San Francisco, California February 7, 2017. REUTERS/Noah Berger

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  • 9th Circuit ruling encourages insurers to cut mental health and addiction services, AGs say
  • Undermines state efforts to direct settlement funds to drug treatment

The attorneys general of Illinois, Connecticut and Rhode Island on Monday called on a federal appeals court to reconsider a ruling allowing insurers to limit mental health and addiction treatment coverage, saying the ruling undermines their efforts to combat a national opioid epidemic.

A three-judge panel of the 9th U.S. Circuit Court of Appeals ruled in March that United Behavioral Health did not have to cover certain mental health and addiction treatment services for tens of thousands of policyholders, leaving the insurer more latitude to define “medically necessary”. treatment.

If allowed to stand, the 9th Circuit’s decision will encourage insurers across the country to cut services for opioid addicts, running counter to a growing medical consensus on the appropriate treatment of addiction, said attorneys general at a press conference.

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“The worst-case scenario is that more people will die,” Connecticut Attorney General William Tong said. “It makes no sense, in the face of America’s worst public health crisis, for insurance companies to prioritize profits over people and stand in the way of treatment and prevention.”

Tong said the 9th Circuit’s decision would shift costs to states and jeopardize state efforts to expand access to drug treatment through large settlements with opioid manufacturers and distributors, including Johnson & Johnson and Purdue Pharma LP.

The three attorneys general filed an amicus brief with the 9th Circuit, supporting the plaintiffs’ bid for en banc review by an 11-judge panel.

A coalition of health care associations, including the American Hospital Association and the American Association for the Treatment of Opioid Dependence, also filed a brief request for en banc review.

United Health Group, which owns UBH, said it is committed to providing health coverage consistent with the terms of its policies and consistent with state and federal rules.

The opioid epidemic has caused more than 500,000 overdose deaths over the past two decades, and it has accelerated in recent years, according to the US Centers for Disease Control and Prevention. More than 107,000 people died of drug overdoses in 2021, and about three-quarters of those deaths involved an opioid, according to CDC statistics.

The plaintiffs, who represented a national class of policyholders, sued UBH in 2014, accusing it of violating the Employee Retirement Income Security Act by not covering mental health and addictions services. which fell within commonly accepted medical recommendations.

The trial court ruled in favor of the plaintiffs in 2020. But the appeals court backtracked, finding that the insurance policies at issue allowed UBH to reject care that did not comply with the generally accepted standards of care, without obliging the insurer to cover all the care that fell. within these standards.

The case is Wit v. United Behavioral Health, 9th US Circuit Court of Appeals, No. 20-17363.

For UnitedHealth: Miguel Estrada of Gibson, Dunn & Crutcher; and Jennifer Romano of Crowell & Moring

For the plaintiffs: Caroline Reynolds and Adam Abelson of Zuckerman Spaeder

(NOTE: This story has been updated to add comment from United Health Group)

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About Evelyn C. Heim

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