iIn a recent decision, the US District Court for the District of Utah granted United Healthcare’s (UHC) motion for summary judgment on the plaintiff’s facial and as-applied claims under the Mental Health Parity Act. If followed more broadly, the district court’s decision could make it difficult for plaintiffs to maintain such claims.
The case arose when the plaintiff’s daughter, who had a history of approved inpatient treatment for mental health disorders, was denied coverage for continued care by UHC after a peer-to-peer review. After the plaintiff exhausted internal and external appeals, he asserted facial and as-applied Parity Act claims against UHC. As to the facial challenge, the plaintiff claimed that the benefit plan imposed requirements more stringent for treatment for mental health disorders at residential treatment centers than for physical illnesses at skilled nursing facilities. With respect to the as-applied claim, the plaintiff alleged that UHC followed generally accepted standards of medical practice for claims for medical/surgical treatment but deviated from such standards for claims involving mental health care in residential treatment centers.
The court granted summary judgment for UHC on both claims. As to the facial claim, the court ruled that resolving the issue would not remedy the plaintiff’s daughter’s injury because UHC did not deny the claim for failing to meet the plan’s requirement for residential treatment; rather, the court held that UHC denied the claim because the daughter was not eligible for continued care at a residential treatment center. With respect to the as-applied claim, the court held that the plaintiff failed to present any evidence, apart from the daughter’s experience, of how the plan evaluates such mental health claims in practice.
The court’s opinion highlights a couple of important takeaways for plaintiffs tackling the already challenging task of asserting successful Parity Act claims. First, plaintiffs must ensure that any facial discrepancy asserted matches the wrong about which the plaintiff complains to avoid redressability issues. For example, the plaintiff needed to assert that the plan imposed requirements more stringent for continued care (rather than merely treatment) at residential treatment centers than for skilled nursing facilities. Second, plaintiffs must be sure, whenever possible, to support as-applied Parity Act claims with evidence obtained through discovery of broad impacts of defendants’ conduct, which may include documents demonstrating disparity in other cases and expert testimony. Absent attention to these important details, Parity Act plaintiffs face high hurdles in maintaining these claims in court.
