Wit vs. United Behavioral Health (UBH) is a landmark case, potentially setting a precedent for how care will be covered for Americans seeking treatment for mental health and addiction.
In a robust and comprehensive 100-plus-page decision in 2019, the United States District Court of Northern California found that UBH was wrong to deviate from the widely accepted clinical standard of care for mental health and addiction. For the remedy, the Judge ordered UBH to reprocess upwards of 67,000 coverage claims for 50,000 patients (half of whom were children) in line with widely accepted clinical standards of care. However, in March of 2022, a three-judge panel at the 9th Circuit Court of Appeals reversed the District Court’s order with a seven-page ruling, arguing that it is “not unreasonable” for insurers to determine coverage inconsistently with generally accepted standards of care.
The disconnect between the robust and comprehensive 100-page plus District Court decision and the cursory 7-page reversal in Wit v. United Behavioral Health is unconscionable. The current ruling will embolden insurers to make decisions out of step with clinical standards. The ripple effects of this case will greatly impact society.
There’s still an opportunity to reverse this ruling and ensure mental health and addiction are treated in alignment with clinical standards. A rehearing from the full 9th Circuit offers an opportunity to revisit the panel’s flawed ruling. Amidst our national mental health and addiction crises, an en banc review is essential.
Plantiff’s response to UBH’s June 2022 reply brief
United Behavioral Health’s reply brief (UBH’s response to the appeal).
Appeal to en banc review (full panel of judges review instead of a small panel).
The Court of Appeals for the Ninth Circuit (3-judge panel) reversed the District Court’s ruling. In a paragraph-long decision, the three judge panel determined that it’s “not unreasonable” for health insurers’ coverage determinations to be inconsistent with generally accepted standards of mental health and addiction care.
Plaintiffs responded to the UBH appeal with their own court filing, contesting UBH’s legal bases on appeal. Additionally, The Kennedy Forum and 25 other advocacy organizations filed an amicus brief —alongside political leaders like California Attorney General Rob Bonta and the U.S. Department of Labor, which filed its own amicus brief—in support of the lower court’s ruling.
UBH attorneys appealed the District Court ruling.
Judge Spero issued a ruling related to the remedy phase of this case. The ruling in the remedy phase of Wit v. UBH required the company to reprocess 67,000 claims using medical necessity criteria established by mental health and addiction clinical specialty associations.
Judge Joseph Spero of the United States District Court for the Northern District of California issued the findings of fact and conclusions of law in Wit v. United Behavioral Health (UBH), a class action brought against the country’s largest behavioral health insurer. The 2019 decision ruled that UBH’s care utilization review guidelines — named the “Level Of Care Guidelines” — were inconsistent with the generally accepted standards of care utilized by the medical community. Rather than following standards that require treating chronic and co-existing treatments together, the court found that UBH followed internally-developed guidelines that limited coverage to solely “acute” episodes or crises.
Key Legal Documents
- District Court of Northern California Decision
- 9th Circuit Court of Appeals Three-Judge Panel Decision
- Amicus Briefs: Ninth Circuit Court of Appeals (May 2021)
- California (Attorney General Bonta)
- Department of Labor
- American Psychiatric Association, American Medical Association et. al
- National Health Law Program, Kennedy Forum, et al (25+ partners)
- Amicus Briefs: Ninth Circuit Court of Appeals, En Banc Review (May 2022)
- American Psychiatric Association, American Medical Association
- California (Attorney General Bonta)
- Rhode Island, Connecticut, and Illinois
- National Health Law Program, Kennedy Forum, et al
- National Association for Behavioral Healthcare/American Psychological Association/American Hospital Association
- United Behavioral Health’s reply brief/appeal response (June 2022)
- Plantiff’s response to UBH’s June 2022 reply brief (June 2022)
For media inquires, contact Amber McLaughlin at firstname.lastname@example.org
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