UnitedHealth Group Unlawfully Denies Treatment for Substance Use Disorder, Class Action Claims

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UnitedHealth Group, Inc. and several affiliate companies have been named in a proposed class action lawsuit that claims the insurance conglomerate has violated federal law by denying coverage for insureds’ substance use disorder and mental health treatment.

The lawsuit explains that the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 mandates that insurance plans that cover mental health treatment must not impose greater limits on coverage for mental health treatment than those imposed on other covered services. Furthermore, the suit continues, the Patient Protection and Affordable Care Act of 2010, also known as the Affordable Care Act or Obamacare, requires that a range of health plans have a “core package” of mental health and substance use disorder services.

Despite these statutory requirements, the defendants, the case argues, have unlawfully denied, underpaid, or delayed coverage for proposed class members’ substance use disorder and mental health treatment by:

• refusing to authorize coverage for detoxification and residential treatment when a facility does not hold an optional state license;
• requiring pre-authorization for partial hospitalization (PHP) and intensive outpatient (IOP) substance use disorder treatment and only authorizing a limited number of days;
• refusing to pay for outpatient treatment for patients with substance use disorders;
• refusing coverage for substance use disorder treatment for patients under one plan based on purported overpayments for such treatment of patients on another plan (known as cross-plan offsetting);
• refusing to pay for breathalyzer tests, counseling services, and services of treatment case managers;
• limiting the number of or refusing to pay for clinical laboratory tests for patients with substance use disorders; and
• paying claims or demanding refunds based on inapplicable Medicare rates.

Moreover, the lawsuit alleges that the defendants have executed these allegedly unlawful policies during “the middle of an opioid crisis,” when receiving substance use disorder treatment can mean the difference between life and death for many patients. From the complaint:

“UnitedHealthcare’s impermissible barriers to substance use disorder treatment must be removed and UnitedHealthcare must be held responsible for placing profits over patients in a life and death situation.”