Judge Blasts Insurer For Policies He Says Effectively Discriminated Against Patients With Mental Health Problems To Save Money
U.S. Chief Magistrate Judge Joseph C. Spero found that United Behavioral Health, the insurer’s unit that administers treatments for mental illness and addiction in private health plans, used overly restrictive guidelines to make its decision on mental health coverage. “There is an excessive emphasis on addressing acute symptoms and stabilizing crises while ignoring the effective treatment of members’ underlying conditions,” he said. He dismissed much of the testimony by UnitedHealth’s experts as “evasive — and even deceptive.” The ruling, if its upheld, could have wide-reaching ramifications for the industry.
Modern Healthcare:
Mental Health Coverage Case Lost By UnitedHealth Unit For Denying Claims
A federal judge ruled Tuesday that United Behavioral Health breached its fiduciary duty to patients by using unreasonable and overly restrictive guidelines to make coverage decisions for tens of thousands of mental health and substance abuse patients. The decision, if upheld on appeal, could have wide ramifications of what insurers must cover in the fast-growing behavioral healthcare sector.The case stems from two consolidated class-action lawsuits filed in 2014 against UnitedHealth Group's United Behavioral Health, the nation's largest behavioral health insurer. (Meyer, 3/5)
The New York Times:
Mental Health Treatment Denied To Customers By Giant Insurer’s Policies, Judge Rules
U.S. Chief Magistrate Judge Joseph C. Spero found that United Behavioral Health, the insurer’s unit that administers treatments for mental illness and addiction in private health plans, had violated its fiduciary duty under federal law. In his 106-page decision, Judge Spero described the company’s guidelines as “unreasonable and an abuse of discretion” and having been “infected” by financial incentives meant to restrict access to care. “There is an excessive emphasis on addressing acute symptoms and stabilizing crises while ignoring the effective treatment of members’ underlying conditions,” he said. He dismissed much of the testimony by UnitedHealth’s experts as “evasive — and even deceptive.” (Abelson, 3/5)
