Affiliates of UnitedHealth Group Inc. the nation’s largest health insurer, have taken their first shot at knocking out a class-action lawsuit claiming they are illegally underpaying reimbursements for mental health services.
Lawyers at Zuckerman Spaeder and Psych-Appeal, Inc. sued United Healthcare Insurance Co. and United Behavioral Health in October, claiming that the companies imposed arbitrary reimbursement penalties for certain psychotherapy services provided by psychologists and master’s-level counselors rather than doctors.
Their client, an anonymous Pennsylvania woman, claimed UnitedHealth reduced the “eligible expense” of charges from her counselor by 35%, even though there would have been no reduction for identical services had they been provided by a physician.
In a motion to dismiss filed by UnitedHealth’s lawyers at Crowell & Moring, the company claims that the lawsuit “challenges the common sense practice that health plans reimburse health care providers with different training, experience, and licensure at different rates.”
“Contrary to plaintiff’s suggestion, it is not unlawful for [the UnitedHealthcare defendants] to pay a social worker less than a licensed physician would be paid for the same service,” the defense lawyers wrote.
UnitedHealth contends that the plaintiff does not identify a covered medical or surgical practice comparable to the reimbursement terms she challenged needed to support a claim under the Mental Health Parity and Addiction Equity Act (MHPAEA) — a 2008 law which added antidiscrimination provisions to the Employee Retirement Income Security Act (ERISA).