Court rules physicians can stand up for their patients

AMA Wire
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Mental health parity gained important momentum this month when a U.S. appeals court ruling gave legal power to patients who face unfair scrutiny or rejection of their mental health claims and enabled their physicians to stand up for this vulnerable population in court.

The New York State Psychiatric Association (NYSPA) in March 2013 brought a class action lawsuit, representing its members, alleging violation of various state and federal laws, including the Mental Health Parity and Addiction Equity Act, the New York Parity Act, the New York Prompt Pay Statute and Employee Retirement Income Security Act (ERISA).

The lawsuit claims that United’s practices were “designed to create the illusion of impartiality, fairness and due process while simultaneously undermining access to treatment for the most vulnerable segment of our society.” Read the details of the complaints at AMA Wire®.

In respect to the lawsuit, United challenged NYSPA’s legal standing to represent the interests of its members and its members’ patients. A trial court dismissed the suit in October, partly on the grounds that NYSPA lacked this standing.

But the 2nd U.S. Circuit Court of Appeals determined NYSPA does in fact have standing to represent its members.

“At this stage in the litigation, it remains plausible that the participation of a limited number of NYSPA members will allow NYSPA to prove that United’s practices violate the relevant statutes,” the court wrote in its decision.

Implications for other cases

The results of NYSPA v. United will have important implications for a similar mental health parity case, American Psychiatric Association v. Anthem Health Plans. In that case, Connecticut psychiatrists are challenging Anthem, alleging that the insurer systematically failed to pay proper mental health and substance abuse benefits.

The allegation is that the insurer failed to abide by beneficiaries’ plans and various laws in the state, including the Mental Health Parity and Addiction Equity Act, ERISA and Connecticut common law. A trial court had dismissed the case, finding that physicians and their medical societies lacked the legal standing to sue under ERISA. Read the details at AMA Wire.

In both cases, the Litigation Center of the AMA and State Medical Societies and the respective state medical societies filed friend-of-the-court briefs to support physicians. To learn more about this and other patient rights cases, visit the Litigation Center Web page.

An additional case originating in New York also is dealing with physicians’ standings under ERISA. The stakes in Rojas v. Cigna Health and Life Insurance Company include termination of physicians from the insurer’s network and medical necessity of services.

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