By Caroline Humer
(Reuters) - The New York State Psychiatric
Association and consumers with health insurance from
UnitedHealth Group Inc on Monday sued the company over
mental health benefits, saying it had not provided the
treatments that federal and state laws require.
The suit, which seeks class action status on behalf of the
psychiatric association's members and other health insurance
customers, seeks to compel UnitedHealth to comply with the law
and cover mental healthcare and seek financial losses.
UnitedHealth is the nation's largest health insurance
company. A spokesman did not have an immediate comment.
The New York State Psychiatric Association, the New York
division of the American Psychiatric Association, said in the
suit it had received many complaints about UnitedHealth's
policies that eliminate, reduce and discourage mental
It said that it requires strict medical criteria and
preauthorizations that it does not place on primary medical
care, whereas the law requires parity. The suit says the company
violates the Federal Parity act, ERISA rules, the Affordable
Care Act, New York state laws, and other laws.
The National Institute of Mental Health estimates that 5
percent of Americans have a serious mental illness, while an
estimated 26 percent of Americans ages 18 and older - about one
in four adults - suffer from a diagnosable mental disorder in a
As these numbers show, the majority of mental illnesses are
mild to moderate, such as moderate depression or anxiety, rather
than severe, such as schizophrenia or psychosis.
In 2006, the last year for which complete data are
available, 36.2 million people paid for mental health treatment,
for a total expenditure of $57.5 billion. Of those, 4.6 million
were children, whose mental health services cost $8.9 billion.
The suit was also filed by Jonathan Denbo and Michael Kamins
on behalf of his son, and Brad Smith on behalf of his son.
Jonathan Denbo receives health benefits through his
employer, CBS Sports Network, according to the documents. The
plan is administered by UnitedHealth, which Denbo said cut off
reimbursement to psychotherapy in late 2012.
Kamins, who was part of a plan offered by the New York State
Health Insurance Program, said that the insurer imposed
substantial obligations on his son in order to obtain
preauthorization for appointments. It permitted only two
sessions per month rather then two sessions per week requested.
Smith receives benefits through SYSCO Corp, for which
UnitedHealth is the plan administrator. His 17-year old son has
received mental health benefits since 2005 and in 2012 was
hospitalized. After initially paying for residential treatment,
the company stopped and required outpatient services.
The case is in Re: New York State Psychiatric Assn Inc,
Michael A. Kamins, Jonathan Denbo and Brad Smith vs UnitedHealth
Group, Southern District of New York, No. 13-cv-01599.
(Additional reporting by Sharon Begley)