National ERISA Parity Act Class Certified

A New York federal judge has certified a class of plan participants suing under the Mental Health Parity and Addiction Equity Act. The certified class is: All persons covered under ERISA-governed health care plans, administered or insured by United Behavioral Health, whose requests for coverage for mental health and substance abuse treatment services received at a licensed residential treatment center were denied in total based on its determination that a component of such services is considered experimental, investigational or unproven.

This is believed to be the first contested multi-plan certified Parity Act case.

The case arose when the plaintiff’s minor son received treatment at an Arizona-licensed residential treatment center. The family’s request for coverage at the facility, however, was denied, because the center offered, among other things, equine therapy. Defendant United Behavioral Health, which administered the family’s health insurance plan, concluded that equine therapy was experimental, investigational or unproven, but denied the entire request for coverage. Plaintiff contends that this denial violates the federal Parity Act because – when United Behavioral Health concludes that medical providers offer services that it believes are experimental, investigational or unproven – only those services are denied. The existence of the contested service doesn’t invalidate all the other services the provider offers.

The class certification order is found here.