UnitedHealth Group, Three Others Named in ERISA, ACA Lawsuit

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A diagnosed anorexia nervosa sufferer from New York claims in a proposed class action lawsuit that UnitedHealth Group, Inc. and three others should be held responsible for damages resulting from the parties’ repeated and categorical refusal to cover her nutritional counseling sessions. In addition to UnitedHealth, the 23-page lawsuit, which cites alleged Employee Retirement Income Security Act of 1974 (ERISA) violations, names Oxford Health Plans, Inc., Oxford Health Insurance, Inc., and Oxford Health Plans (NY), Inc. as defendants.

The plaintiff’s health insurance program, the Oxford Freedom Plan, for which UnitedHealth is an ERISA fiduciary, reportedly covers a broad range of in-network and out-of-network treatment for mental illnesses, including eating disorders. To help combat her condition—a severe mental illness—the plaintiff began receiving specialized nutritional counseling from a licensed and registered dietician.

Despite repeatedly seeking coverage, the plaintiff has had to pay out-of-pocket to cover the cost of her nutritional counseling sessions due to the defendants’ alleged refusal to pay for the service. From here, the complaint wages the defendants, specifically UnitedHealth, breached its fiduciary and legal duties by essentially discriminating against the plaintiff. The allegation stems from the company’s alleged practice of providing coverage under the plaintiff’s health plan for nutritional counseling for non-mental health conditions, such as diabetes.

The defendants’ denials of coverage for the plaintiff’s nutritional sessions, the complaint continues, also allegedly violate certain provisions with the Affordable Care Act—specifically its Federal Parity Act—and Timothy’s Law, New York’s state mental health parity law.