States fight back after United Behavioral Health gets coverage denial lawsuit tossed

Since 2019, states have been in a back-and-forth dispute with behavioral health provider United Behavioral Health, a subsidiary of health insurer UnitedHealth Group, to determine whether the insurer inappropriately denied coverage to subscribers. In the latest update on the case, last week, 15 state attorneys general, along with the attorney general of Washington D.C., requested a review of a recent ruling that suggested that UBH did inappropriately deny subscribers coverage, but that subscribers would not be able to get their claims re-processed, according to the Providence Business News.

The saga began in 2019, when a court ruling in the case Wit v. United Behavorial Health (UBH) determined that United Behavioral Health had unfairly denied coverage of treatment to subscribers. Instead of following state criteria to determine whether a patient was eligible for treatment coverage, UBH applied a more limited set of guidelines, the Rhode Island Attorney General’s office said in a press release.

However, the ruling was reversed in March 2022 by the Court of Appeals for the Ninth Circuit. Subsequently, Rhode Island’s attorney general, along with the attorneys general of Illinois and Connecticut, filed an amicus brief requesting a review of the case, per the Rhode Island Attorney General’s office. That review was granted, and in January of 2023, a new judge determined that the original 2019 ruling was correct and UBH was unfair in their imposition of standards for treatment, the Providence Business News reports. At the same time, the judge said that subscribers who suspected they were denied coverage for unfair reasons would not be able to get their claims reviewed.

In response to the decision, the attorneys general of Rhode Island, Connecticut, and Illinois, along with 12 other state attorneys general and the attorney general of Washington D.C., have filed a request to have that decision reconsidered, this time so that patients who were denied reimbursement for care can receive coverage.

Related: Recent federal actions significantly enhance access to substance use disorder treatment

In the new request, the attorneys general state that the ruling could “exacerbate the difficulties that many patients face in accessing medically necessary treatment for mental health and substance use disorder services, and thus increase the public health risks and dangers that result from such lack of treatment access,” per Providence Business News.

“We are on the cusp of major change when it comes to mental health and addiction treatment in this country,” said Patrick J. Kennedy, a former US Representation and founder of The Kennedy Forum, in a 2022 press release about the initial state appeal. “No longer will we accept subpar coverage from our insurers for behavioral challenges that dramatically impact health and well-being.”

Speaking to the Providence Business News, a United Healthcare spokesperson said that UHG is “committed to ensuring members have access to mental health care consistent with the terms of their health plans in compliance with state and federal rules.”