United Health Faces Class Action Brought by Insureds Seeking Mental Health Coverage

Posted on: August 28th, 2013 by Steve Larson
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bouton croixLawyers for a putative class of policyholders argued that United Health should be forced to provide mental health treatment to customers with severe behavioral disorders until a proposed class action over the insurer’s coverage practices is resolved.

Policyholders argued for a preliminary injunction three days after urging the court to reject United Health’s bid to dismiss the suit. The suit alleges “a panoply of illegal policies and practices that have improperly led to the denial of plaintiffs’ claims, putting their lives at risk.”

The injunction request accuses United Health of adopting four improper tactics designed to make it exceedingly difficult to acquire coverage for mental health care, allegedly in violation of various state laws, the Affordable Care Act, the Employee Retirement Income Security Act and the Mental Health Parity and Addiction Equity Act.

One unacceptable burden is UnitedHealth’s requirement that patients present “compelling evidence” that their psychological conditions will deteriorate without care, despite such proof not being demanded of people seeking traditional medical-surgical benefits, the court filing alleges.

Similarly, the insurer blocks coverage for specific levels of care unless a customer can prove they face significant and imminent harm if a less-intense style of care is tried first, the injunction request says.

A third practice involves requirements for pre-approval before covered mental health services are allowed, and the fourth tactic has seen UnitedHealth cut off benefits before internal administrative appeals are exhausted, the filing says.

As a result, the policyholders face a choice of depleting their savings to pay for care or simply halting treatment altogether and risking dire consequences, the plaintiffs argue in a memorandum supporting the motion for an injunction.

Several of the plaintiffs are seeking coverage for their children, including one who is said to suffer from psychosis and suicidal tendencies, and another who is described as intellectually gifted but deeply traumatized by sexual abuse at the hands of his estranged mother.

The case is New York State Psychiatric Association Inc. et al. v. UnitedHealth Group, case number 1:13-cv-01599, in the U.S. District Court for the Southern District of New York.