Mental Health Benefit Disputes on the Rise

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A new article in the American Bar Association’s Health Law Section’s eSource describes an “upward trajectory” in health plan disputes involving coverage of mental health benefits. The trend is likely to continue as the patients, medical providers, and health insurers as payers struggle to understand and appreciate evolving treatments within the coverages afforded by health plans.

In the wake of a recent White House task force finding that compliance with the Affordable Care Act’s mental health parity provisions was lagging, and election results which may find the Affordable Care Act being all or partially dismantled, a new article in the American Bar Association’s Health Law Section’s eSource describes an “upward trajectory” in health plan disputes involving coverage of mental health benefits. Dallas, Texas attorney Jonathan M. Herman is the author of the article in the ABA publication that points to a significant increase in mental health coverage lawsuits since 2014. Mr. Herman is also the publisher of Managed Care Litigation Update®, a practice resource that tracks emerging issues and significant cases in health care litigation and he frequently defends major health insurers in coverage disputes.

In the ABA article, Mr. Herman points to a rise mental health disputes from 3% of managed care litigation cases in 2014 to 16% of cases thus far in 2016. According to Mr. Herman’s study of managed care litigation, the greatest increase in cases involves disputes over coverage for mental health treatment at residential treatment centers.

“Individuals struggling with mental illness naturally want the most advanced treatment at such facilities” says Mr. Herman. “And insurers struggle with the requirement that health policies offer mental health benefits that are in parity with medical benefits but are being billed by out of network facilities often unknown to them.”

Ultimately Mr. Herman says that this is a trend that is likely to continue as the patients, medical providers, and health insurers as payers struggle to understand and appreciate evolving treatments within the coverages afforded by health plans. And regardless of changes which may be in store for the Affordable Care Act under the new administration, Mr. Herman says that patients will continue to demand coverage for mental health benefits at or equal to medical benefit levels.

Jonathan M. Herman’s Managed Care Litigation Update® is a bi-weekly electronic publication which reports on new case filings and analyzes case trends with each quarter ending issue. Subscriptions are available at http://www.managedcarelitigationupdate.com. In addition to defending large health insurers, plan administrators, and self-funded employer health plans, Mr. Herman is an Arbitrator for the American Arbitrator Association and a Neutral for the American Health Lawyers Association. Herman Law Firm has offices in Dallas, Texas (principal office) and New Orleans, Louisiana.

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Tim Crouch

Tim Crouch
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