Benefits and ERISA attorney who led successful efforts for insured autism treatment looks at current legal trends as youth mental health claims skyrocket
Media Contact: Barbara M. Fornasiero, EAFocus Communications; firstname.lastname@example.org; 248.260.8466
Royal Oak, Mich.— April 26, 2022— Hefty medical bills are adding to family financial woes caused in part by the growing need for specialized teen mental health services that are not being fully covered by health insurance plans. National employee benefits and ERISA attorney J.J. Conway of Michigan-based J.J. Conway Law, who was involved in landmark litigation granting previously denied insurance coverage for specialized health services for children with autism, is now working with families to help them obtain coverage or reimbursement for medical expenses for teens who need extended mental health treatment for conditions including eating disorders, self-harming behaviors and substance abuse.
“Inpatient treatment is often warranted in cases where teens are experiencing a mental health crisis, and most families simply cannot afford to pay for these treatments out-of-pocket,” Conway said. “The pandemic exacerbated the problem and the number of mental health claims among children are rising – and the cost of treatment is increasing. The old methods of using generically applied treatment guidelines are being closely scrutinized because the current coverage is not adequate.”
In December 2021, the U.S. Surgeon General issued its Protecting Youth Mental Health: A Surgeon General Advisory. The report looked at several factors influencing the rise in adolescent and teenage mental health issues, from social media to the effects of the pandemic. Troublingly, the report noted a record 51% increase in attempted suicides in early 2021 for adolescent girls when compared with the same measuring period in 2019. The report also noted that one in three high school students and half of female students reported persistent feelings of sadness or hopelessness, an overall increase of 40% over the past decade.
Conway notes that following the Surgeon General’s advisory, the Ninth Circuit Court of Appeals surprisingly reversed landmark employee benefits case, Wit, et al. v. United Behavioral Health, et al., in which a federal district court in the Northern District of California overturned more than 60,000 claim denials, including parents seeking residential treatment for their children struggling with a range of mental health conditions including eating disorders and other self-harming behaviors. The patients are expected to seek a re-hearing on May 5, 2022, along with other expected interest groups filling briefs in support of the appeal.
The Ninth Circuit’s reversal in Wit may be an outlier and may not be the final decision in the case, Conway says. He points to the Employee Retirement Income Security Act of 1974 (ERISA) as a factor that can be considered in these claims. ERISA is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans, and when the law isn’t upheld, the plans are subject to federal review.
“When an employee benefit plan’s rationale for denying a mental healthcare claim violates ERISA’s fiduciary standards, federal courts are increasingly comfortable overturning those denials,” Conway commented. “As mental health continues to be a growing concern in American society, these claims are bound to grow, and the insurance industry will be forced to adapt – not deny.”
Until wide-scale insurance changes take place, families will be forced to deal with unplanned medical expenses that truly can’t be budgeted.
“Even high earners can’t afford hundreds of thousands of dollars of uninsured or underinsured treatment costs for their children. Families cannot act as reinsurers,” Conway said. “As with insurance coverage for children with autism, though, I believe we are on the precipice of a major, positive change in the insurance industry.”
About J.J. Conway Law
J.J. Conway Law was founded by John Joseph (J.J.) Conway in 1999 to work with individuals seeking full access to the employee benefits they have earned. The firm has been involved with nationally significant employee benefit, disability and pension cases, including class action lawsuits for such landmark decisions as requiring Michigan private insurers to cover autism health treatments for children through age 18 and protecting the pension rights of City of Detroit employees, police and firefighters as well as Wayne County employees by holding their trustees accountable for investment decisions. The firm’s motto is “Conquer Tomorrow®” and is dedicated to making tomorrow easier for their clients across the United States. Learn more on the firm’s website.