Aetna Faces Class-Action Lawsuit for Alleged Mental Health Treatment Discrimination

More and more people are seeking mental health treatment since the beginning of the pandemic. Isolation, job loss and other significant changes to lifestyle have hit many hard, sending them in search of reassurance and assistance. Insurance mega player, Aetna, has recently been served with a class-action lawsuit regarding its acceptance rates for claims related to mental health services. The U.S. District Court in the Central District of California received the claim this week on the grounds that claims for residential services were denied based on a 2008 law regarding mental health parity.

About the Claim

The case stems from events in 2019 in which an Aetna customer enrolled his teenage son into a Utah mental health residential treatment facility. The young man is diagnosed with autism spectrum disorder. Aetna denied the plaintiff's claim. According to the claim, the criteria Aetna uses for claim acceptance eligibility is far more stringent than those accepted by general professional mental health standards. It is alleged that the rationale behind this discrepancy is in order to "minimize the number of claims accepted and thereby maximizing Aetna's own profits," states the lawsuit. The complaint also indicates that, "Aetna treats mental health as less important than mental health."

Aetna's Stance

Aetna defends their decision to deny coverage on the basis that the claim's desired mental health facility does not meet certain policy standards. They say that the center lacks accreditation by a professional organization such as the Committee on Accreditation of Rehabilitation Facilities, the Joint Commission, the Council on Accreditation or the American Osteopathic Association's Healthcare Facilities Accreditation Program.

Another reason Aetna believes the facility fails to meet criteria is due to the fact that it does not have a behavioral health provider on duty seven days a week, 24 hours a day. In addition, this particular facility's patients are treated by a psychiatrist on an as-needed basis, rather than at least once a week as Aetna policy requires. The plaintiff's attorneys responded with the rebuttal that the standards Aetna uses for mental health care do not exist for surgical or physical health benefits. They are advocating against this discrepancy.

The Mental Health Parity and Addiction Equity Act

The basis for the plaintiff's case lies in the contents of legislation known as The Mental Health Parity and Addiction Equity Act of 2008. Their complaint states that Aetna's denial of the plaintiff's claim goes against this legislation and is, therefore, illegal. The Parity Act exists to prohibit insurance providers from discriminating against mental health claims and advocates for equal access to these services. The act lays forth the premise that, if a company offers mental health coverage, it must be "at parity" with other benefits. Basically, this means that insurance companies cannot deny behavioral health, mental health or addictions claims at a higher rate, nor require more stringent standards, than they do medical and surgical benefits.

The plaintiff's lawyers in this case assert that Aetna has, indeed, violated the terms of the Mental Health Parity and Addiction Equity Act of 2008. They believe that the company's policy application standards are unbalanced and unfair. They would like Aetna to reprocess the initial claims made by the plaintiff for treatment in the residential mental health facility program.

Potential Ramifications of This Case

Thus far, there is only this one plaintiff involved in the case. However, that plaintiff's legal team believes there is the potential for other Aetna customers who have experienced similar mental health claims denial to be added to the litigation. It is their assertion that a "substantial number" of other Aetna customers have been treated discriminately. A past suit against United Healthcare regarding mental health parity was won, and a large settlement had to be paid by the company. This sets a precedent indicating there is potential for the Aetna case to have a similar outcome.

It would seem that there may be an avenue for others to pursue legal action if they believe they have been wronged by Aetna. According to the law, mental health claims must be decided using standards equal to those of other types of benefits.

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