Consumer Fraud

Landmark Mental Health Ruling Finds Top Insurer Illegally Denied Patients Coverage

Contract for WEB Landmark Mental Health Ruling Finds Top Insurer Illegally Denied Patients CoverageMental health patients in the U.S. scored major victory when a federal judge issued a landmark ruling against the nation’s largest health insurer, finding that it has been illegally denying coverage to policyholders seeking treatment for mental health and substance abuse.

United Behavioral Health, a unit of UnitedHealthcare, “deviated” from national health care standards by implementing cost-cutting policies that effectively deprived mental health patients of access to critical, life-saving treatments, U.S. Chief Magistrate Judge Joseph Spero found. He also suggested that the company was more intent on feeding its bottom line than providing adequate and appropriate coverage to mental health patients.

Judge Spero’s ruling comes in response to a class-action lawsuit representing more than 50,000 people who were denied coverage for mental health treatment by United Behavioral Health.

The judge also blasted the insurance company’s medical directors, saying they provided “deceptive” testimony under oath.

“[United Behavioral Health’s] experts … had serious credibility problems,” Judge Spero wrote. “The Court found that with respect to a significant portion of their testimony each of them was evasive — and even deceptive — in their answers when confronted with contrary evidence.”

The insurer implemented a “model that keeps benefit expenses down by placing a heavy emphasis on crisis stabilization and an insufficient emphasis on the effective treatment of co-occurring and chronic conditions,” Judge Spero found, saying that the company ignored patients’ underlying conditions and restricted coverage instead to “acute signs and symptoms.”

This model flies in the face of well-established treatment standards for mental health and substance abuse disorders, which are aimed at preventing relapse or a deterioration in the patient’s condition and level of functioning.

In addition to federal violations, United Behavioral Health broke state laws in Illinois, Connecticut, Rhode Island and Texas by denying patients necessary treatments, the judge found.

Former Rhode Island representative Patrick Kennedy, who now acts as a mental health advocate, told CNN that Judge Spero’s ruling was “scathing and breathtaking at the same time,” adding that the decision could “be used to understand how all the insurance companies are doing this.”

“The insurance industry is hellbent on violating the federal law, and they’re doing so with impunity. Now, we have a federal court specifically and forensically breaking down how they get around the federal law,” he said.

Other mental health advocates widely praised the ruling, emphasizing its value in a time when life expectancy in the U.S. has been in decline because of what Mr. Kennedy called a “public health crisis in mental health and addiction.”