A Connecticut law firm has taken the lead in a high-profile federal lawsuit that accuses a group of insurance companies of overcharging for mental health services, prompting thousands of vulnerable patients to avoid treatment.
In the American Psychiatric Association v. Anthem Health Plans lawsuit, the firm of Murtha Cullina was hired as chief legal counsel for the plaintiffs. Attorney Marie Pepe VanDerLaan of the firm's Hartford office, the lead lawyer in the case, filed the complaint on the APA's behalf in U.S. District Court in New Haven.
At the heart of the claim is that the insurance company manipulated billing statements in order to charge higher co-pays for patients being treated for mental disorders than those required for patients with physical ailments. The APA is a lead plaintiff in the case, joined by psychologist Susan Savulak of Newington and several of her patients.
The practice of charging higher co-pays to psychiatric patients, if proven to be true, could be a violation of the federal Mental Health Parity and Addiction Equity Act. As a result of requiring extra pre-approval for treatment and additional co-pays, the insurance company's actions have resulted in patients scheduling fewer doctor visits, the lawsuit claims. That drop in patient visits has prompted some psychiatrists to leave the Anthem coverage network in the state, the plaintiffs maintain.
As a result of there being fewer psychiatrists in the Anthem Health Plans network to choose from, insured patients are having more trouble getting prompt access to treatment, the lawsuit said. VanDerLaan said the lawsuit is part of a national effort to ensure that all insurance companies treat patients in the psychiatric realm the same as everyone else.
"This case is about eliminating the hurdles imposed by insurance companies to mental health treatment," VanDerLaan said during a recent interview. "Despite the Mental Health Parity Act, which makes it illegal to discriminate against mental health treatment, stigmas still exist and access to quality care remains challenging."
The lawsuit, filed April 10, named Anthem and subsidiaries Anthem Blue Cross Blue Shield and Wellpoint as defendants. It is the fourth such lawsuit to be filed in the country since the parity law was strengthened in 2008, requiring insurance companies to use the same billing standards for mental health treatment and regular medical services. Similar lawsuits are pending in district courts in California and New York.
Last year, the U.S. District Court in Vermont was the first to rule in favor of mental health patients who claimed they were treated differently than people seeking treatment for physical ailments. In C.M. v. Fletcher Allen Health Care Inc., the court ruled that the insurance plan violated the mental health parity act by enacting pre-approval procedures for routine mental health services that were not required for non-mental health services.
While Anthem and its affiliates have not yet formally responded to the Connecticut lawsuit, corporate officials have already publically announced plans to change their fee schedule. "Anthem Blue Cross and Blue Shield understands how critical access to mental health services is to the overall health of our members," the company said in a prepared statement.
That change in policy, including an agreement to reconsider 28,000 cases and pay back about $400,000 collected in co-payments, isn't slowing the APA's efforts to obtain injunctive relief. "As long as these hurdles to accessing care exist, those who need care will continue to suffer," VanDerLaan said. "That needs to stop."
She's seeking a court order to prevent Anthem Health plans from billing mental health claims at higher rates than other claims. The lawsuit also seeks a declaratory decision that would prohibit other companies from engaging in similar behavior.
According to the lawsuit, the insurance company started reducing the amount it would pay to Connecticut psychiatrists for office visits. The insurance company at the same time imposed an additional co-payment on the patients who obtain mental health treatment services. That extra co-payment, the plaintiffs argue, is a violation of the mental health parity law.
The lawsuit says Anthem refused to pay for psychiatric patients to receive psychotherapy at the same appointment where the patient is initially evaluated medically, meaning that an extra appointment was necessary. Beyond delaying treatment, the policy increased the number of co-payments for each patient, the lawsuit says.
"The APA worked hard to ensure the passage of the Mental Health Parity Act so that mental health patients would not be deprived of treatments," said Dilip Jest, president of the APA. "Anthem, Wellpoint and other companies throughout the U.S. need to start respecting the law and out members' patients and not directly or indirectly inhibit access to the treatment for which the patients and their employers have paid."
Kathleen Flaherty, a staff attorney with Statewide Legal Services in Hartford and a member of Governor Dannell Malloy's Sandy Hook Advisory Commission, knows all too well what many mental health patients face when dealing with insurance companies. She overcame bipolar disorder to earn a Harvard law degree, and is now licensed to practice in Connecticut, Massachusetts and New York.
"I think part of the issue about mental health parity is the hoops that the insurance companies make patients jump through," Flaherty said.
Her practice as a legal aid lawyer includes handling housing discrimination and employment discrimination matters. In that professional capacity, she does not deal with claims of insurance companies making it difficult on patients with mental illness, she said.
But in her own life, Flaherty said, she's been prompted to write more than a few letters to insurance companies about denial of coverage or excessive costs for prescription medications. "It's something you deal with," she said. "I'm lucky, because I'm a lawyer." There have been a few instances where she's written a letter to an insurance company that has increased my co-payments or the amount a prescription costs out of pocket. "And they back right down," she said. "I'm lucky, because I can sign my name with 'esquire' after it. But most patients aren't that lucky."
Sheldon Toubman, an attorney with the New Haven Legal Assistance Association, said his office assists indigent people who are covered under Medicaid. For those patients, he said, the mental health parity laws are not an issue, because coverage is for the most part provided. "It's not really something we see here," he said. "Sometimes payment is refused, and we fight those when they happen, but it's not the same because these patients aren't paying co-payments" for their care.
But for those with private insurance, an extra co-pay charge to see a mental health specialist can be a trigger that pushes a patient away from seeking treatment. The lawsuit states that one in five Americans will suffer from mental illness during their lifetime, and 5 percent will suffer a severe mental illness. But less than one-third of those who need treatment will have access to the treatment they need to live normal productive lives.
"Some will not seek treatment because of the stigma associated with mental illness," the complaint says. "Others, who are courageous enough to seek treatment despite unfair stigma, are denied the medically necessary treatment they seek, or are discouraged from obtaining such medically necessary treatment by health insurance companies, like the defendants, who are intent on making a profit at the expense of the patients who pay the fees and the psychiatrists who care for them."
David Shapiro, who is chair of the Disability Law Section of the Connecticut Bar Association, said he expects all lawyers in the state who represent individuals with mental illness will have a "great interest in the outcome of the case."
"This is a problem that occurs frequently in Connecticut, because we have many people who are do not qualify for public assistance or coverage provided by the State of Connecticut," Shapiro said. "But at the same time, they are unable to afford the co-pays required by clinics and private doctors. This is particularly troubling when it is psychiatric treatment that is set aside because of the inability to pay."•