A landmark ruling in 2019 required insurers to define “medical necessity” in accordance with accepted clinical standards. But in 2022, a three-judge panel threw out that ruling, allowing insurance companies to determine coverage by “arbitrary, profit-motivated, and internally developed criteria.”
The ruling is a big step backwards for patients with SUD or mental health challenges, as well as their Loved Ones and communities. As the author of this article in The Hill notes, overdose is now the leading cause of death for Americans aged 14-23, while over 40 million Americans are seeking substance use treatment every year. Since the March 2022 ruling, insurance companies have a much easier time denying coverage to all these people in need.