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Am. Psychiatric Ass'n v. Anthem Health Plans, Inc.

United States Court of Appeals, Second Circuit

May 13, 2016

AMERICAN PSYCHIATRIC ASSOCIATION, on behalf of its members and their patients, et al., Plaintiffs-Appellants,
v.
ANTHEM HEALTH PLANS, INC., et al., Defendants-Appellees

         Argued September 21, 2015

Page 353

[Copyrighted Material Omitted]

Page 354

         Appeal from the United States District Court for the District of Connecticut. No. 3:13 Civ. 494 -- Janet Bond Arterton, Judge. Plaintiffs-Appellants are two individual psychiatrists, Susan Savulak, M.D., and Theodore Zanker, M.D. (" the psychiatrists" ), and three professional associations of psychiatrists, the American Psychiatric Association, the Connecticut Psychiatric Society, Inc., and the Connecticut Council of Child and Adolescent Psychiatry (collectively, " the associations" ). They brought suit in the United States District Court for the District of Connecticut against Defendants-Appellees, four health-insurance companies: Anthem Health Plans, Inc. (doing business as Anthem Blue Cross & Blue Shield of Connecticut); Anthem Insurance Companies, Inc. (doing business as Anthem Blue Cross and Blue Shield); Wellpoint, Inc.; and Wellpoint Companies, Inc. (collectively, " the health insurers" ). The psychiatrists and the associations allege that the health insurers' reimbursement practices discriminate against patients with mental health and substance use disorders in violation of the Mental Health Parity and Addition Equity Act of 2008 (" MHPAEA" ), Pub. L. No. 110-343, Div. C § § 511-12, 122 Stat. 3861, 3881, codified at 29 U.S.C. § 1185a, and the Employee Retirement Income Security Act (" ERISA" ), 29 U.S.C. § § 1001-1461 . The associations brought suit on behalf of their members and their members' patients, while the psychiatrists brought suit on behalf of themselves and their patients. The district court dismissed the case after concluding that the psychiatrists lacked a cause of action under the statute and the associations lacked constitutional standing to pursue their respective claims. We AFFIRM.

         AARON M. PANNER (Matthew A. Seligman, on the brief), Kellogg, Huber, Hansen, Todd, Evans & Figel, P.L.L.C., Washington, D.C., for Plaintiffs-Appellants.

         PETER R. BISIO (Jessica L. Ellsworth, Erica K. Songer, Sean Marotta, on the brief), Hogan Lovells U.S. LLP, Washington, D.C., for Defendants-Appellees.

         D. Brian Hufford and Jason S. Cowart, Zuckerman Spaeder LLP, New York, N.Y., and David A. Reiser, Washington, D.C., for Amici Curiae American Medical Association and Connecticut State Medical Society in support of Plaintiffs-Appellants.

         Before: WALKER and RAGGI,[1] Circuit Judges.

          OPINION

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          John M. Walker, Jr., Circuit Judge

         Plaintiffs-Appellants are two individual psychiatrists, Susan Savulak, M.D., and Theodore Zanker, M.D. (" the psychiatrists" ), and three professional associations of psychiatrists, the American Psychiatric Association, the Connecticut Psychiatric Society, Inc., and the Connecticut Council of Child and Adolescent Psychiatry (collectively, " the associations" ). They brought suit in the United States District Court for the District of Connecticut against Defendants-Appellees, four health-insurance companies: Anthem Health Plans, Inc. (doing business as Anthem Blue Cross & Blue Shield of Connecticut); Anthem Insurance Companies, Inc. (doing business as Anthem Blue Cross and Blue Shield); Wellpoint, Inc.; and Wellpoint Companies, Inc. (collectively, " the health insurers" ). The psychiatrists and the associations allege that the health insurers' reimbursement practices discriminate against patients with mental health and substance use disorders in violation of the Mental Health Parity and Addition Equity Act of 2008 (" MHPAEA" ), Pub. L. No. 110-343, Div. C § § 511-12, 122 Stat. 3861, 3881, codified at 29 U.S.C. § 1185a, and the Employee Retirement Income Security Act (" ERISA" ), 29 U.S.C. § § 1001-1461. The associations brought suit on behalf of their members and their members' patients, while the psychiatrists brought suit on behalf of themselves and their patients. The district court dismissed the case after concluding that the psychiatrists lacked a cause of action under the statute and the associations lacked constitutional standing to pursue their respective claims. We AFFIRM.

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         BACKGROUND

         The psychiatrists and the associations allege that the health insurers discriminate against patients with mental health and substance use disorders by systemically reimbursing providers of services to treat these disorders at a less favorable rate than for other healthcare services. They argue that this less favorable reimbursement policy prevents many psychiatrists from accepting health insurance. The policy limits patients' access to necessary services and frequently forces them to change providers. Plaintiffs allege that this practice discriminates against patients with mental health and substance use disorders in violation of the MHPAEA and ERISA.

          Congress enacted the MHPAEA to end discrimination in the provision of insurance coverage for mental health and substance use disorders as compared to coverage for medical and surgical conditions in employer-sponsored group health plans. See Coalition for Parity, Inc. v. Sebelius, 709 F.Supp.2d 10, 13 (D.D.C. 2010). The MHPAEA expanded the scope of prior legislation, the Mental Health Parity Act of 1996, Pub. L. No. 104-204, § § 701-02, 110 Stat. 2874, 2944.

         Under the MHPAEA, if a covered insurer's " plan or coverage" does not include aggregate lifetime limits " on substantially all medical and surgical benefits, the plan or coverage may not impose any aggregate lifetime limit on mental health or substance use disorder benefits." 29 U.S.C. § 1185a(a)(1)(A). The same is true with respect to annual limits. Id. § 1185a(a)(2)(A). Additionally, if an insurer " provides both medical and surgical benefits and mental health or substance use disorder benefits," the insurer must ensure that both " the financial requirements" and " the treatment limitations" applicable to mental health and substance use disorder benefits " are no more restrictive" than the predominant financial requirements and treatment limitations that apply to medical and surgical benefits. Id. § 1185a(a)(3)(A).

         Insurers are forbidden, for example, from having either " separate cost sharing requirements that are applicable only with respect to mental health or substance use disorder benefits," § 1185a(a)(3)(A)(i), or " separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits," id. § 1185a(a)(3)(A)(ii); see also 26 U.S.C. § 9812(a)(3) (parallel provisions in Internal Revenue Code); 42 U.S.C. § 300gg-5(a) (" A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable State law." ).

         The psychiatrists and the associations, on behalf of their various patients and members (and in the case of Dr. Savulak, as assignee of two of her patients), allege that the health insurers' conduct violates the foregoing anti-discrimination provisions of the MHPAEA and breaches the insurers' fiduciary duties under § 502(a)(3) of ERISA. The psychiatrists and the associations also allege state-law claims for breach of contract and tortious interference with contract. The complaint seeks a declaration of the health insurers' obligations under the MHPAEA; an order enjoining the health insurers from continuing to discriminate against individuals with mental health and substance use disorders; and damages related to the state-law claims.

         The district court (Janet Bond Arterton, J. ) dismissed the action. The district court ...


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