Plaintiffs demand UnitedHealth beef up mental health coverage

The UnitedHealth Group
The UnitedHealth Group Inc.'s campus in Minnetonka, Minn. Attorneys for the plaintiffs in a class action lawsuit against UnitedHealth have filed their rebuttal to the big insurer's arguments.
Jim Mone | AP 2012

Plaintiffs in a class-action lawsuit against Minnetonka-based UnitedHealth have filed their rebuttal to the company's arguments challenging the remedies they're seeking in the lawsuit.

A federal judge in California has already found in favor of the plaintiffs accusations that UnitedHealth's coverage for behavioral health care is substandard. Now, lawyers expect, the judge will schedule oral arguments before making a final decision about proposed remedies.

Back in March, chief federal magistrate judge Joseph C. Spero of the Northern District of California ruled that United Behavioral Health, a subsidiary of UnitedHealth Group, violated its responsibilities to its members needing mental health and substance use treatment. People represented in the case were covered by UnitedHealth plans between 2011 and mid-2017, and were denied coverage for mental and behavioral health care. Spero found the company prioritized treatment of acute behavioral health and substance use needs, but did not adequately cover treatment for the underlying conditions.

Spero wrote that the company's decisions were based "as much or more on its own bottom line as on the interests of the plan members, to whom it owes a fiduciary duty."

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The plaintiffs argue UnitedHealth should be required to come up with new guidelines for how it covers behavioral health, and to then use those guidelines to re-evaluate claims it previously denied. The plaintiffs are also asking that a monitor be appointed to oversee the re-evaluations.

UnitedHealth's response argued that, among other things, many of the 50,000 people included in the class action shouldn't be.

"They're coming up with a lot of different reasons, making a lot of legal arguments to try to limit what kind of remedies are being imposed on them and arguing the court doesn't have the authority to do it," said plaintiffs attorney, D. Brian Hufford.

In a statement UnitedHealth said “…we will continue to work towards solutions that ensure our members have access to support for their behavioral health care needs.” The company also said it has adopted new guidelines for both substance use and mental health coverage “with the goal of implementing [these changes] effective in 2020.”

Editor's note (July 16, 2019): This story has been updated from the original to incorporate comments from UnitedHealth Group, which the company sent after the story was first published.