Mental health parity is at the center of a case between physicians and Anthem, Inc., one of the largest health insurers in the country.
In American Psychiatric Association v. Anthem Health Plans, Connecticut psychiatrists are challenging the insurer, alleging that Anthem systematically failed to pay proper mental health and substance abuse benefits under beneficiaries’ plan documents and under various laws in the state, including the Mental Health Parity and Addiction Equity Act, the Employee Retirement Security Act (ERISA) and Connecticut common law.
The complaint alleged that Anthem reimbursed psychiatrists less than non-psychiatric physicians who provided comparable medical services and imposed unnecessary administrative requirements on psychiatrists. A trial court dismissed the case, finding that physicians and their medical societies lacked the legal standing to sue under ERISA.
“Anthem’s unequal treatment of mental health care is a direct attempt to diminish the availability and use of mental health services,” the AMA told the appeals court in a friend-of-the-court brief filed by the Litigation Center of the AMA and State Medical Societies and the Connecticut State Medical Society.
The brief calls out Anthem’s tactics as restrictive to patients’ access to psychiatric care, pointing to the AMA Code of Medical Ethics as the basis for why Connecticut psychiatrists have standing to advocate for their patients.
“Physicians have a ‘close relationship’ that makes them proper representatives of the patient’s legal rights when there are obstacles to the patient’s assertion of her own rights,” the brief said, referring to the social stigmas mental health patients face. “The harm to patients from Anthem’s discrimination between mental health care and medical and surgical care is intertwined with concrete injury to the treating physicians.”
For example, physicians who remain in Anthem’s networks receive reduced compensation and face road blocks to proper treatment of patients. Meanwhile, other physicians may be forced out of Anthem’s networks, hurting access to care.
A similar case currently in the federal appeals court tackles the same issue. In New York State Psychiatric Association v. UnitedHealth Group, New York psychiatrists also claimed that the insurer’s practices were impartial and unfair, while simultaneously undermining access to treatment for mental health and substance abuse patients.
To learn more about this and other patient rights cases, visit the Litigation Center Web page.
