United Healthcare Faces Class Action over Restricted Mental Health Coverage

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Los Angeles, CA: A class action lawsuit has been filed against United Healthcare Insurance Company, US Behavioral Plan, and California United Behavioral Health, which contracts with employers such as the University of California to provide mental health services to policyholders.

The class-action suit alleges that these companies, which are part of United Healthcare Insurance Company, have violated the California Mental Health Parity Act, which requires insurers to provide treatment for mental-health diagnoses according to "the same terms and conditions" applied to medical conditions. Specifically, the defendants are accused of denying and improperly limiting coverage by conducting concurrent and prospective reviews of routine outpatient mental health treatments when no such reviews are conducted for routine outpatient treatments for other medical conditions. Defendants are also accused of violating the Unruh Act, by discriminating against a class of persons with mental disabilities and psychiatric conditions; violating California's law prohibiting unfair competition, breaching the terms of its own insurance contract with policyholders, and the implied covenant of good faith and fair dealing.

The law suit was filed in Santa Barbara Superior Court on behalf of the plaintiff, who works in Santa Barbara. Her mental health coverage was improperly reduced. She was having four weekly outpatient psychotherapy sessions. But in September, 2011 she was informed that she would limited to one weekly session for one month.

Plaintiff is represented by the Los Angeles-based class-action trial lawyers of Cohen McKeon LLP, and Meiram Bendat, founder of the mental health insurance-advocacy service, Psych-Appeal. "This is an important case because it addresses an issue that impacts a wide range of people who are covered by health insurance" said lead attorney, Michael L. Cohen. "For too long, people who suffer from severe mental health issues have not received health insurance coverage on the same terms as conditions that are applied to other conditions." Specifically, the lawsuit seeks certification of a class consisting of hundreds and perhaps thousands of UC employees who were subject to improper review and denial of treatment for severe mental health illnesses.

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Reader Comments

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UnitedHealthcare refuses to negotiate rates with non-participating providers. These are providers willing to accept the in-network rate. United says they have providers in network who have comparable skills. They do not look at experience or combination of skills, or even client preference in determining whether they will negotiate with an out-of-network provider. In this case, United is favoring its business interests over the clinical appropriateness of the decision. It is not even clear how refusing to negotiate individual contracts at their participating provider rates is either harmful to their business or to their clients.

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