Anthem's headquarters
The Mental Health Parity and Addiction Equity Act is at the center of a lawsuit brought against Anthem Blue Cross Blue Shield and several self-funded benefit plans that alleges they underpaid mental health and substance abuse treatment claims to an out-of-network provider.
The act prevents health plans from providing less coverage for mental health and substance use disorder treatment than they do for medical and surgical services, according to a law.com article about the lawsuit. The claims brought under the Mental Health Parity and Addiction Equity Act apply to both ERISA and non-ERISA plans, according to the complaint. The article said this is a developing area of law and it is unclear what remedies are available.
The lawsuit was filed by All Points North, which is the trade name of affiliated entities that operate treatment facilities in Colorado for individuals who suffer from and seek treatment for substance use disorders, trauma, and other mental illnesses. The defendants include Anthem and self-funded plans administered by Anthem, including benefit plans funded by Goodwin Procter, Amazon, Wells Fargo, State Farm, Davita and Microsoft.
All Points North said it has been unable to negotiate a fair rate with Anthem to become an in-network provider. The company is also engaged in a separate lawsuit with Anthem over what it says is a payment scheme for out-of-network providers in which the insurer gives payment for claims directly to the policyholder, said the article. In addition to violating Colorado law, giving large sums of money to the patient rather than the provider has led to overdoses and at least one death, the company alleges.
Anthem approved care for patients receiving treatment at All Points North but then undercut payment for services, according to the lawsuit. This destabilizes the financial security of providers, and reduces access to care for mental health conditions and substance abuse disorders, the complaint says.
"The rates that Anthem and the plans have compensated All Points North at are lower, even, than All Points North's cost to provide essential mental health services to individuals seeking mental health and substance use disorder treatment in already-underserved areas of Colorado," the complaint claimed. "This systematic underpayment of claims for treatment at All Points North by the defendants is gradually jeopardizing the ability of one of the only providers of subacute residential treatment on the western slope of Colorado to continue to provide this critical care."
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