In the first case in the country interpreting the Mental Health Parity and Addiction Equity Act of 2008, Langrock attorney Alison Bell achieved a significant decision on behalf of her client, who suffers from mental health issues, and mental health patients generally.
In general, the Act requires that health insurance plans administer mental health benefits in parity with medical/surgical benefits. More specifically, the standards, factors, and processes used in determining benefits for mental health claims must be comparable to, and applied no more stringently than, those used in determining benefits for medical/surgical claims.
That general rule does allow an exception, if “recognized clinically appropriate standards of care” permit differing treatment. In C. M. v. Fletcher Allen Health Care, Inc., the defendant argued that the plaintiff had to prove that there were no such standards of care. The court emphatically rejected that argument, and held that plans that seek to take advantage of the exception bear the burden of proof. Bell noted, “this is significant because it clearly puts the burden on the insurance industry to provide clinically appropriate standards of care to justify treating mental health claims differently. Mental health patients have a right to know whether they are being treated differently than patients with other physical or surgical issues, and if so, on what clinical grounds the insurance companies justify that difference.”
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