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Psychiatry groups' lawsuit over low Anthem reimbursements nixed

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A federal appeals court ruled Friday that several psychiatrists and associations cannot sue four Anthem Inc. health insurers on grounds they discriminated against patients by reimbursing mental health and substance abuse treatments at a lower rate than other health care services.

Judges for the 2nd U.S. Circuit Court of Appeals upheld a lower court ruling that the psychiatrists lacked “a cause of action” and the associations lacked constitutional standing to sue the health insurers over reimbursement rates.

The American Psychiatric Association, the Connecticut Psychiatric Society Inc. and the Connecticut Council of Child and Adolescent Psychiatry along with two individual psychiatrists sued Anthem Health Plans Inc., Anthem Insurance Cos. Inc., Wellpoint Inc. and Wellpoint Cos. Inc.

They alleged the insurers violated the Mental Health Parity and Addition Equity Act of 2008 and breached their fiduciary duty under the Employee Retirement Income Security Act by discriminating against mental health and substance abuse disorder patients through “systemically reimbursing providers of services to treat these disorders at a less favorable rate than for other health care services.”

Under the Mental Health Parity and Addition Equity Act, insurers cannot impose greater financial requirements or treatment limits on services for mental health and substance abuse than they do for other medical and surgical benefits, according to the court opinion.

But the appeals court did not decide the merits of the lawsuit, ruling instead that the psychiatrists do not have the authority to file a lawsuit under ERISA. Only a participant, beneficiary or plan fiduciary could bring such litigation, the appeals court panel ruled unanimously.

“We find that the plaintiff psychiatrists lack a cause of action under the statute, and the association plaintiffs lack constitutional standing to pursue their respective ERISA and MHPAEA claims. We therefore affirm the judgment of the district court,” the appeals court ruled.