United Behavioral Health facing renewed legal woes
A new complaint argues that the guidelines the company used to deny claims were excessively restrictive.
United Behavioral Health is back in court again. The company, which administers UnitedHealth Group’s substance abuse care benefits and mental health care benefits for employer-sponsored health plans, is being sued over its coverage policies.
“This case arises from UBH’s deliberate development of policies designed to reduce the number and value of claims UBH would approve, thereby serving the financial interests of UBH, its affiliates and the employer plan sponsors they consider their customers,” according to the complaint. “The UBH policies at issue in this case all disregard or directly flout the terms of the plaintiffs’ plans and were developed to serve UBH’s interests and those of its plan sponsor customers rather than those of the plan members. As a result, the policies all breach the fiduciary duties UBH owes to all ERISA plan members, including plaintiffs.”
The complaint argues that the guidelines United Behavioral Health used to deny these claims were excessively restrictive and also opposes its bundled payment policy.
Related: UnitedHealth to pay $14.3M in ‘landmark’ settlement over mental health parity law
According to the legal team, the bundled payment model tied together all services completed in a single day. These services could include inpatient, residential or partial hospitalization services. If the level of care provided in that day exceeded United Behavioral Health’s standards, it denied all of that day’s services, not merely the services that the company considered unnecessary.
“Using this all-or-nothing policy, UBH rejects services that it concedes are medically necessary by forcing them to be linked together with others that UBH may have a legitimate reason to deny,” said D. Brian Hufford, a partner at the law firm Zuckerman Spaeder. “If UBH properly authorized coverage for at least some of the services provided in residential treatment, more patients would be able to afford this level of care, which is often a lifesaving option for patients.”
UnitedHealth Group said it will defend United Behavioral Health’s actions.
“We are committed to ensuring all our members have access to care consistent with the terms of their health plan and state and federal rules — and will vigorously defend ourselves in this case,” a company representative told HealthPayerIntelligence.
In August, UnitedHealthcare settled a lawsuit with the U.S. Department of Labor and the New York State attorney general regarding reimbursement parity. The case ended with United Behavioral Health paying $13.6 million to beneficiaries and $2 million in penalties.
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