California Attorney General Weighs In On Coverage For Mental Health

Lori Kalani, Bernard Nash
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  • California AG Rob Bonta filed an amicus brief in the U.S. Court of Appeals for the Ninth Circuit in support of plaintiffs-appellees in Wit v. United Behavioral Health (“UBH”), where the district court found that plaintiffs-appellees were improperly denied coverage for mental health and substance use disorder treatment by mental health administrator UBH.
  • The district court found that UBH breached its fiduciary duty to plaintiffs when it denied coverage for medically necessary treatment on the basis of clinical guidelines that fell short of the standard of care, and that UBH relied on clinical criteria that were narrower than the generally accepted standards of care in order to cut costs. The court issued a remedies order requiring UBH to use clinical criteria that adhere to generally accepted standards of care in its coverage decisions, and UBH appealed the order.
  • The amicus brief argues that the district court’s remedial order ensures that Californians are able to access medically appropriate and necessary mental health care and that reversing the order would likely harm California because it spends public resources on individuals with private insurance when they are denied medically necessary care by their insurer, among other things.
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