Wit v. United Behavioral Health II

Brief filed: 3/23
Court: U.S. Court of Appeals for the Ninth Circuit (Full Panel)
Year of Decision: 2022

Read full-text amicus brief (PDF, 346B)opens in new window

This is an en banc (full panel) review of the earlier decision (see Wit v. UBH I) by a three-judge panel of the Ninth Circuit Court of Appeals. The issue is whether a health insurer is in violation of the Employee Retirement Income Security Act (ERISA) if it ignores generally accepted medical standards and uses its own cost-based guidelines when making determinations on which behavioral health services will be considered “medically necessary” and thus covered by the plan.

Mental Health Parity

After the initial decision of the Ninth Circuit three-judge panel, plaintiffs petitioned for a rehearing of the case en banc (i.e., by the full panel of the Ninth Circuit). However, in January 2023, while the petition for rehearing was still pending, the three-judge panel vacated its order and issued a new one, on its own accord, siding with the plaintiffs on certain legal issues and with UBH on others. The new order still did not provide the relief sought by the plaintiffs and would still allow UBH to use its own guidelines when determining coverage.

APA again joined with the National Association of Behavioral Health and other related groups to submit a brief that echoed that of the previous briefs, focusing on the necessity for parity of mental health care and that affirming a judgment in favor of UBH would have severely restrict patient access to appropriate care for mental health and substance use disorders.

Pending