Ruling limiting mental health benefits undermines fight against addiction, three AGs say

3 minute read

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

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  • 9th Circuit ruling emboldens insurers to scale back mental health and addiction services, AGs say
  • Undermines state efforts to direct settlement funds toward addiction treatment

The attorneys general of Illinois, Connecticut and Rhode Island on Monday called on a federal appeals court to reconsider a decision allowing insurers to limit coverage for mental health and substance abuse treatment, saying the ruling undermines their efforts to combat a nationwide 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, allowing the insurer greater leeway to define "medically necessary" treatment.

If allowed to stand, the 9th Circuit's decision will embolden insurers across the nation to cut back on services to opioid addicts, going against a growing medical consensus about the proper treatment for addiction, the attorneys general said 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, when facing the worst public health crisis in America, for insurance companies to prioritize profits over people, and to stand in the way of treatment and prevention."

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

The three attorneys general filed an amicus brief to the 9th Circuit, backing the plaintiffs' bid for en banc review by a panel of 11 judges.

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

United Health Group, which owns UBH, said that it was committed to providing health coverage that matched the terms of its policies and complied 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 U.S. 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 drug, according to CDC statistics.

Plaintiffs, who represented a nationwide class of policyholders, sued UBH in 2014, accusing it of violating the Employee Retirement Income Security Act by failing to cover mental health and substance abuse services that fell within commonly accepted medical recommendations.

The lower court ruled in the plaintiffs' favor in 2020. But the appeals court reversed, finding that the insurance policies at issue allowed UBH to reject care that was outside the generally accepted standards of care, without requiring the insurer to cover all care that fell within those standards.

The case is Wit v. United Behavioral Health, 9th U.S. 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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