August 12, 2021
Date: Thu, Aug 12, 2021 at 1:43 PM
Subject: FW: Attorney General James and U.S. Department of Labor Deliver $14 Million to Consumers Who Were Denied Mental Health Care Coverage
|FOR IMMEDIATE RELEASE
August 12, 2021
Attorney General’s Press Office/212-416-8060 email@example.com
Attorney General James and U.S. Department of Labor Deliver $14 Million
UnitedHealthcare Unlawfully Denied Coverage to 20,000 New Yorkers
NEW YORK – New York Attorney General Letitia James and the U.S. Department of Labor (USDOL) today announced landmark agreements with UnitedHealthcare (United), the nation’s largest health insurer, to resolve allegations that United unlawfully denied health care coverage for mental health and substance use disorder treatment for thousands of Americans. As a result of these agreements, United will pay approximately $14.3 million in restitution to consumers affected by the policies, including $9 million to more than 20,000 New Yorkers with behavioral health conditions who received denials or reductions in reimbursement. New York and federal law requires health insurance plans to cover mental health and substance use disorder treatment the same way they cover physical health treatment. The agreements — which resolve investigations and litigation — address United’s policies that illegally limited coverage of outpatient psychotherapy, hindering access to these vital services for hundreds of thousands of New Yorkers for whom United administers behavioral health benefits. In addition to the payment to impacted consumers, United will lift the barriers it imposed and pay more than $2 million in penalties, with $1.3 million going to New York state.
“In the shadow of the most devastating year for overdose deaths and in the face of growing mental health concerns due to the pandemic, access to this care is more critical than ever before,” said Attorney General James. “United’s denial of these vital services was both unlawful and dangerous — putting millions in harm’s way during the darkest of times. There must be no barrier for New Yorkers seeking health care of any kind, which is why I will always fight to protect and expand it. I thank Secretary Walsh for his partnership on this important matter.”
“Protecting access to mental health and substance use disorder treatment is a priority for the Department of Labor and something I believe in strongly as a person in long-term recovery,” said U.S. Secretary of Labor Marty Walsh. “This settlement provides compensation for many people who were denied full benefits and equitable treatment. We appreciate Attorney General James and her office for their partnership in investigating, identifying, and remedying these violations.”
New York’s behavioral health parity law — originally enacted as “Timothy’s Law” in 2006 — and the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) require insurance coverage for mental health and substance use disorder treatment to be no more restrictive than insurance coverage for physical health conditions. The agreements are the product of the first joint state-federal enforcement of these laws.
The Office of the Attorney General’s (OAG) complaint — which parallels USDOL’s complaint — was filed in the U.S. District Court for the Eastern District of New York, along with the agreements. Each complaint describes two practices by United that the agencies allege violated behavioral health parity laws through discriminatory practices that improperly restricted coverage of psychotherapy:
1) Reimbursement Penalty
2) Algorithms for Effective Reporting and Treatment (ALERT) program
United’s illegal and discriminatory practices have impeded access to behavioral health services for more than half a million New Yorkers with fully-insured United health plans and many others with self-insured private health plans administered by the company.
Under the agreements, United will stop applying the Reimbursement Penalty and will not employ a new, similar policy in New York for at least two years. United will also discontinue applying the ALERT program — and will cease issuing denials — for psychotherapy in New York, and will not implement a new outlier management program until at least 2023.
This case is being handled by Assistant Attorney General Michael D. Reisman of the Health Care Bureau, which is overseen by Deputy Bureau Chief Leslieann Cachola. The Health Care Bureau is a part of the Division for Social Justice, which is led by Chief Deputy Attorney General Meghan Faux and overseen by First Deputy Attorney General Jennifer Levy.