New proposed class action continues Manchester United’s legal dilemma


On Thursday, six people attacked the largest behavioral health insurance company in the United States with a class action lawsuit, accusing United Behavioral Health of continuing to unreasonably and universally deny coverage for mental health and substance abuse treatment.

The lawsuit filed in the Northern District Court of the San Francisco Branch of California, the U.S., echoed the claim and extended Wit and so on. al vs. United Behavioral Health, A sort of 2019 landmark cases The case found that United had violated the fiduciary obligations of the Federal Employee Retirement Income Protection Act to approximately 50,000 members and based its behavioral health insurance decisions on deliberately flawed guidelines in order to increase profits.

Court order in November 2020 UBH is required to reform its claims handling so that underwriting decisions are based on the generally accepted standards of care outlined by the non-profit medical group. The judge also ordered UBH to reprocess more than 67,000 related claims. UBH has appealed this decision and is currently in court.

Caroline Reynolds, a partner at Zuckerman Spaeder LLP, a Washington, DC-based law firm, said wit sets a legal precedent for generally accepted standards of care that insurance companies must rely on when making decisions about patient insurance. Now represents the plaintiff in the proposed class action.

“This is indeed the first ERISA class action lawsuit to resolve such guidelines on a broad, class-wide basis, and make sure that administrators are still bound by the terms of these programs, and they must use generally adopted standard care, not free Use something more restrictive,” Reynolds said.

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The Wit case only covers UBH members whose insurance companies rejected the underwriting request from May 2011 to June 1, 2017.

A separate class action lawsuit has been filed against members whose claims were denied between June 2, 2017 and early February 2018, and the lawsuit is still ongoing.

This new case aims to represent “thousands” of patients who refused to receive mental health and substance abuse treatment between February 2018 and 2019. The decision to accuse UBH’s coverage of being too broad has helped increase the profits of insurance companies while at the same time Saving money for its self-funded clients makes it more likely that employers Reynolds said they will continue to rely on insurance companies to manage their claims.

A spokesperson wrote in an email that UBH’s policy complies with state and federal laws, and the insurance company plans to actively defend itself in this situation.

The spokesperson said: “As part of our broader commitment to quality care, we will continue to support our members, increase their access to providers, and quickly obtain the effective behavioral support they need in new ways.”

According to the lawsuit, UBH’s internal policy outlines behavioral health insurance, at the expense of patient health, prioritizing the financial interests of insurance companies, and allowing members to pay for medical expenses at high out-of-pocket expenses.

In one example, UBH told Barbara Beach that although the doctor said that the girl’s suicide attempt, self-harm, and medical diagnosis required longer hospitalization, it would only provide her daughter with 12 days of hospitalization in an inpatient treatment facility. According to the complaint, stay. Instead, the insurance company said it would provide treatment for the girl in a partial hospitalization plan 1.5 hours away from her place of residence. The complaint stated that Beach was unable to transport her daughter to and from the nearest facility. As long as she can afford it, she will continue to receive her daughter’s treatment in an inpatient facility.

Since UBH requires the agency to bundle all of its services into a single daily bill, it is able to reject the claim based on its decision that hospitalization is not “medically necessary”, even if some of the hospitalization plans will cover and provide the same Service. Reynolds said that insurance companies require providers to bundle their services into a single bill. This represents a new strategy for denying claims because it allows insurance companies to refuse all treatments provided, even if some of these components may have been used by individuals. Underwriting.

“The problem is that when these really restrictive coverage standards are applied, providers usually provide medical advice to individuals who need to receive treatment for a longer period of time,” Reynolds said. “So some people will stay in this level of care for longer, but UBH will not pay anything. Even if they accept some services recognized by UBH as necessary.”

The lawsuit stated that in the end, the beach was unable to allow her daughter to participate in the hospitalization program. The girl went home early and was admitted to the hospital for drug overdose shortly after she was discharged, and eventually attempted suicide and died.

Reynolds said: “Patients are basically faced with the option of either having to pay for the entire treatment out of their own pocket, or being forced to accept a treatment different from the treatment recommended by the provider or abandon the treatment altogether.”

Although federal and state laws require insurance companies to cover behavioral care as well as physical condition care, patients often encounter major problems Let the operator pay For the treatment needed, Reynolds said.

For example, she pointed out UnitedHealthcare’s decision, From July 1st, When a fully insured customer seeks non-emergency care outside the state, the insurance company will no longer pay for out-of-network claims. Under the new policy, Patients will no longer be able to receive treatment from “lower-level” facilities outside their place of residence, including in-patient treatment plans and in-patient rehabilitation teams.

If this policy is extended to self-insurance customers, Reynolds said she is not sure whether this policy meets the standards of the Mental Health Equality and Addiction Treatment Act, which requires insurance companies to evaluate their policies to ensure they do not Disproportionately reject behavioral health insurance.

“I often describe the problems employees face when trying to obtain the medical insurance required in their plans as a game of’fighting the mole’,” Reynolds said. “Insurers have discovered more subtle forms of discrimination, such as these non-quantitative restrictions. We do see a lot, and it is an ongoing struggle to stay ahead of all the different restrictions imposed.”



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