Two interesting developments took place after writing last week about United Behavioral Health deploying policies and guidelines based on a profoundly dangerous misunderstanding of clinical depression. The first is the large number of emails I’ve received from stakeholders across the spectrum of people involved in outpatient mental health care with similar–and even worse—stories. More on that in a subsequent post. Here I want to share news about UBH being sued for they way they ration care for profit, a suit that might hold them accountable for denying needed care.
I recently learned that this month a class-action lawsuit has been filed against California United Behavioral Health (UBH), along with United Healthcare Insurance Company and US Behavioral Plan, alleging these companies improperly denied coverage for mental health care.
According to the class action lawsuit, United Behavioral Health violated California’s Mental Health Parity Act, which requires insurers to provide treatment for mental-health diagnosis according to “the same terms and conditions” applied to medical conditions. Specifically, the insurer is accused of denying and improperly limiting mental health coverage by conducting concurrent and prospective reviews of routine outpatient mental health treatments when no such reviews are conducted for routine outpatient treatments for other medical conditions.
Furthermore, writes Michael Cohen of Cohen Mckeon LLP, Los Angeles-based class-action trial lawyers who filed the law suit along with Meiram Bendat, founder of the mental health insurance-advocacy service, Psych-Appeal:
Defendants are also accused of violating the Unruh Act, by discriminating against a class of persons with mental disabilities and psychiatric conditions; violating California’s law prohibiting unfair competition, breaching the terms of its own insurance contract with policyholders, and the implied covenant of good faith and fair dealing.
The lead plaintiff in the case is reported to be a woman who was improperly denied coverage. While receiving 4 weekly psychotherapy sessions she was abruptly told that she would have coverage for one session per week for one month — just like the case I described last week.
And as I’ll post in a couple of days, based on information I’ve received from other clinicians, UBH employees, and those who work on the employer-based benefit side, UBH does seem to have a business model in which they put people’s lives at risk by making care decisions loosely connected to clinical realities. Why they do it is a question that gets to the heart of the matter: Is managed care, aka, care rationing for profit, even necessary for outpatient mental and behavioral health care? Might it be the case that there is just not enough waste in outpatient mental and behavioral health care to justify the cost of the services they provide? Might the rationing they do only generate sufficient profit by denying care to people who should be receiving it? And perhaps most important of all: If your mental health treatment is subject to UBH’s rationing procedures, is there anything you can do?
[FULL DISCLOSURE: I currently own 8.5 shares of UNH across two mutual funds. United Behavioral Health also operates under the brand name OptumHealth Behavioral Solutions. Both United Behavioral Health and OptumHealth Behavioral Solutions are business units of UnitedHealth Group (NYSE: UNH).]
- United Behavioral Health Sued For Denying Needed Care
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- Years after passage of mental health parity law, gaps remain