Pension & Benefits Daily™ covers all major legislative, regulatory, legal, and industry developments in the area of employee benefits every business day, focusing on actions by Congress,...
May 23 — UnitedHealthcare Insurance Co. and United Behavioral Health are “systematically and improperly” denying claims for mental health and substance-abuse related health benefits in violation of federal mental health parity law, a new class action complaint alleged .
According to the complaint, these benefit denials are motivated by a desire to avoid the “often high costs associated with the treatment of chronic conditions.”
The complaint, filed May 21 in the U.S. District Court for the Northern District of California, seeks class treatment for three proposed classes of health plan participants and beneficiaries who were denied coverage for nutritional counseling or for residential treatment for mental health or substance use disorders.
A spokesperson for UnitedHealthcare told Bloomberg BNA May 23 that the company is currently reviewing the complaint.
The complaint was filed by three individuals who had been denied coverage for mental health and/or substance abuse treatment by Employee Retirement Income Security Act-governed health plans administered by UnitedHealthcare.
They accused the insurer of violating the federal Mental Health Parity and Addiction Equity Act of 2008 in two broad ways.
First, they alleged that UnitedHealthcare routinely violated plan terms covering mental health benefits by adjudicating claims “based on internal practices and policies that are much more restrictive than those generally accepted by the mental health community.”
Second, they argued that the insurer violated the federal parity act by imposing “disparate and more restrictive internal policies and practices” to claims for mental health and substance abuse benefits.
According to the plaintiffs, UnitedHealthcare's internal policies effectively provided that coverage would be denied for residential treatment if a lower level of treatment would be safe, regardless of whether it would be similarly effective. Further, they contended that the internal guidelines focused on “acute changes” in claimants' circumstances and failed to properly account for “chronically severe impairments.”
The guidelines also provided that coverage for residential treatment will be denied unless a claimant can show that he or she will imminently suffer a “significant deterioration in function,” the plaintiffs argued.
These “restrictive” guidelines discriminate against patients with mental illness, the plaintiffs asserted, because they aren't imposed upon patients seeking coverage for medical or surgical benefits. Further, they aren't in line with generally accepted standards for assessing appropriate levels of mental health care, the plaintiffs argued.
The complaint was filed by Psych-Appeal Inc., Zuckerman Spaeder LLP and the Maul Firm P.C.
Text of the complaint is at http://www.bloomberglaw.com/public/document/Wit_et_al_v_UnitedHealthcare_Insurance_Company_et_al_Docket_No_31.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to firstname.lastname@example.org.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to email@example.com.
Put me on standing order
Notify me when new releases are available (no standing order will be created)