The Second Circuit recently ruled that a group of health plan participants, and an association of mental health care providers, could sue a self-insured health plan TPA under ERISA for mental health parity violations. The TPA in question was subjecting mental health claims to preauthorization and concurrent review policies, but not medical claims. All TPAs, plan sponsors and insurers should be performing a thorough analysis of not only plan policy provisions but also administrative practices to ensure that any administrative requirements are the same for mental health claims and medical claims.
N.Y. State Psychiatric Ass’n v. United Health Grp., No.14-20-cv (2d Cir. Aug. 20, 2015)