OPINION: Mental health coverage for Alaskans is in jeopardy

In Alaska, there are more than 108,000 people living with a mental health condition — more than three times the population of Juneau. Not all of those Alaskans get the medical care that they need. Of the more than 29,000 residents in Alaska who did not receive needed mental health care last year, 42.1% did not get care because of the cost. Access to care remains a challenge for many people with mental illness in Alaska. We know it can sometimes take months to schedule a preliminary appointment with a behavioral care specialist here, especially in rural Alaska. The recent telehealth legislation passed this session will help to bring services to patients sooner, and behavioral health caregivers are ramping up their professional staff over time to address the growing demands. But coupled with the fact that many people do not understand their appeal rights if they experience a denial from an insurance company, filing an appeal to challenge their insurer’s denial of treatment is challenging, complicated, expensive, and time-consuming.

Unfortunately, Alaskans’ ability to receive adequate and comprehensive mental health coverage from their insurers is under further threat. A class action suit involving over 50,000 plaintiffs, Wit v. United Behavioral Health (UBH), could negatively affect their behavioral health care coverage. In a 2019 decision originally celebrated as a landmark win for people seeking mental health and addiction treatment, the U.S. District Court for Northern California found that UBH created flawed criteria for determining whether to cover mental health and addiction treatment. This included two 100+ page decisions describing how UBH made medical coverage decisions based on its own financial interests that were not accepted clinical standards.

Tragically, in March 2022, a decision made by a three-judge panel on the Ninth Circuit Court of Appeals, which includes Alaska, reversed this ruling. This new ruling would permit the largest insurer in the country to put its own financial interests ahead of mental health patients’ needs, setting a dangerous legal precedent. The ripple effects of this case will impact more than 130 million Americans’ health coverage, including Alaskans. In a moment where access to care is paramount, the current ruling is not only out of touch with clinical standards of care for mental health patients, but also limits access to care altogether.

Resolution is possible. As a landmark case, Wit v. UBH will have an enormous impact on whether health plans are allowed to continue to put their own financial interests ahead of the interests of patients needing mental health and addiction care — allowing insurers, rather than medical experts, to dictate patient outcomes. National Alliance on Mental Illness (NAMI) recently signed onto an amicus brief with the Kennedy Forum to request that the full 9th Circuit Court of Appeals revisit the panel’s ruling. We strongly urge the full 9th Circuit Court of Appeals to rehear this case and provide crucial clarity for patient parity both statewide and nationally.

Shirley Holloway serves as president of NAMI National. Richard Fagnant is president of NAMI Alaska, Inc. Ann Ringstad is executive director of NAMI Alaska, Inc.

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