Coloradans have a right to equitable coverage of mental health and addiction care under the Mental Health Parity and Addiction Equity Act of 2008 (Federal Parity Law), which requires insurers to cover treatment for mental health and substance use disorders no more restrictively than treatment for illnesses of the body, such as diabetes and cancer.
But because the law is not adequately enforced by state and federal regulators, insurers continue to wrongly deny or limit life-saving treatment in an effort to suppress costs.
Just weeks ago, a federal court issued a scathing decision in Wit v. United Behavioral Health (UBH), finding that the largest managed behavioral health care company in the country illegally rejected the insurance claims of tens of thousands of people seeking mental health and addiction treatment services based on defective, internally developed medical review criteria.
At a time when life expectancy is decreasing largely due to overdoses and suicides, UBH’s actions and contempt for the Federal Parity Law are unacceptable.
The flawed criteria at the heart of this case were designed to approve coverage with a primary focus on “acute” episodes, such as when individuals are suffering from severe withdrawal or are actively suicidal.
This is not sufficient, given that mental health and substance use disorders, like other conditions such as diabetes and heart disease, most often require long-term care.
We wouldn’t dare deny someone coverage for medical treatment following a heart attack. Why should it be any different for someone with a mental health or substance use disorder?
The court also ruled that UBH’s guidelines improperly required reducing the level of care, such as removing patients from residential treatment programs to some form of outpatient therapy, even if the providers who were treating them believed — consistent with generally accepted clinical standards — that maintaining a higher level of care was more effective.
To help prevent such harmful practices moving forward, more states must take action and pass robust laws to bolster the Federal Parity Law and finally hold insurers accountable through specific, state-based enforcement efforts. A bill currently in front of the Colorado House would do just that. And the stakes are high.
A recent report by Milliman found that, due to inadequate networks of care provided by insurers, Coloradans must go out of network7.6 times more often for inpatient mental health and addiction care than for inpatient medical/surgical care.
People depend on their health insurance to pay for treatment. The costs incurred from out-of-network care are often enough to deplete savings or retirement accounts and cause many to stop treatment.
Wit v. United Behavioral Health is a wake-up call for insurers and should also be a wake-up call for Colorado legislators and the Colorado Division of Insurance.
Legislators must pass House Bill 19-1269 immediately, and the Division of Insurance must conduct market conduct exams to ensure that health plans are not using discriminatory medical necessity criteria for members with mental health and substance use conditions.
In 2008, the Federal Parity Law provided a strong roadmap for change, but now it is time for states to prioritize enforcement efforts and improve transparency to make the law’s promise a reality.
For far too long, it has been business as usual for insurers. Wit v. United Behavioral Health shines a much-needed spotlight on the critical need for parity and provides the catalyst we need for lasting change.
READ: Colorado Sun opinion columnists.
Colorado has an opportunity to send a clear message that the separate and unequal system of care currently faced by those with mental health and substance use disorders will no longer be tolerated.
Don’t let it pass by. Join us in the fight for mental health equity and show the nation what’s possible when we stand up for parity rights.
When someone in Colorado makes that critical decision to get help for a mental health or substance use concern,nothing should stand in their way. Act now and save lives.
Patrick J. Kennedy is the founder of The Kennedy Forum and, while serving as a U.S. Representative, D-R.I., from 1995 to 2011, was a co-author of the Federal Parity Law.
Rep. Lisa Cutter is a member of the Colorado House of Representatives from the 25th district in Jefferson County and is co-prime sponsor of HB19-1269.
Rep. Tom Sullivan is a member of the Colorado House of Representatives from the 37th district in Arapahoe County and is co-prime sponsor of HB19-1269.
Sen. Joann Ginal is a member of the Colorado Senate from the 14th district in Larimer County and is the prime Senate sponsor of HB19-1269.