This week, a federal judge in Northern California has slammed that the UnitedHealth Group Inc., an American health care company based in Minnetonka, Minnesota, has violated its responsibilities when it comes to offering patients with mental health care and substance use disorder treatment.
The court has brought a class-action lawsuit against “United Behavioral Health,” which represents people who are covered by UnitedHealth plans from 2011 to 2017 were denied coverage for the treatment of mental health issues and substance use problems.
The suit accused the Minnesota-based company of restricting access to acute and immediate mental health care and substance use needs, refusing to pay for the treatment of underlying, long-standing conditions.
U.S. Chief Magistrate Judge, Joseph C. Spero, wrote, “At every level of care, ‘there is an excessive emphasis on addressing acute symptoms and stabilizing crises while ignoring the effective treatment of members’ underlying conditions.” He also wrote, “The result is a ‘significantly narrower scope of coverage that is consistent with generally accepted standards of care.’”
The judge said the reason was clear – profits. He wrote, “The company-based coverage decisions were based as much or more on its own bottom line as on the interests of the plan members, to whom it owes a fiduciary duty.”
D. Brian Hufford, one of the attorneys of the plaintiffs, said in a phone interview, “The problem is that these issues are not merely acute. The acute is a result of the underlying chronic condition and unless you focus on the chronic condition, you’re really never going to be able to help that patient fully address their issues.”
To put in other words, an insurance company agrees to cover a patient’s heart attack but not the treatment for hypertension or dyslipidemia that are the risk factors of a heart attack.
Hufford explained that behavioral health is exceptional to these kinds of coverage denials because more complicated and chronic medical conditions leave room for the companies to utilize discretion about when to cover treatment.
UnitedHealth has not responded to this class-action lawsuit. However, it has been quoted in other news outlets, saying, “We remain committed to providing our members with access to the right care for the treatment of mental health conditions and substance use disorders.”
The federal law is supposed to ensure that mental health care needs should be covered in the same way physical health care needs are. However, many say that this is not the case, particularly when there is an acute need. There have been lawsuits pending against other companies as well. UnitedHealth could ultimately appeal the decision.
