United Behavioral Health lawsuit: Patients petition for case to be reopened

Thousands of patients have called on a federal court to overturn a landmark ruling allowing a UnitedHealth Group subsidiary to develop mental and substance abuse coverage guidelines that deviate from clinical standards. accuse of.

The plaintiffs filed a petition with the 9th Circuit Court of Appeals on Friday requesting a three-judge panel to rehear their case. The American Medical Association, American Psychiatric Association, several states and others have submitted amicus curiae briefs in support. UnitedHealth Group did not immediately respond to a request for an interview.

The case stems from two consolidated class-action lawsuits filed in 2014 against United Behavioral Health, in which plaintiffs alleged that the insurer protected 1974 employee retirement age by developing unfair criteria for denying mental health and substance abuse patients. had breached its fiduciary duty under the Income Security Act. UnitedHealth Group cannot be relied upon to create internal standards that follow established clinical guidelines because the company benefits from denying claims, the plaintiffs contended.

a federal district court ruled in favor of the plaintiff in 2019, Chief Magistrate Judge Joseph Spero of the US District Court for the Northern District of California ordered United Behavioral Health to reprocess 67,000 claims and follow guidelines announced by medical societies. The decision sent shock waves through the insurance industry by setting a legal standard for how carriers should develop coverage policies.

UnitedHealth Group appealed the decision, arguing that it is allowed to develop internal criteria for assessing medical necessity. panel of three judges side with the insurer And last year overturned a district court ruling, ruling that the company is not required to cover every treatment prescribed by physicians and that reprocessing of claims is not permitted under ERISA.

In the petition for appeal, the patient plaintiffs counter that reprocessing is permitted under federal law and that the insurer must rely on accepted medical standards to review claims.

“The Panel observed that, contrary to the express terms of the Schemes, [United Behavioral Health] The petition states that the medical community can instead evaluate medical need using the preferred standards of their finance department. “This finding, as dozens of emcees have pointed out to this court, is both wrong and an irreparable blow to the nation’s fight against the mental health and addiction crisis.”

United Behavioral Health Faces a Separate, ongoing class-action lawsuit with similar claims, which covered patients whose mental and substance abuse care UnitedHealth Group reviewed from June 2017 to February 2018.

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