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February 1, 2021 On Friday in the District of Utah, Judge Ted Stewart denied United Behavioral Health (UBH) and Motion Picture Industry Health Plan for Active Participants’ motion to dismiss a claim by individual plaintiffs that alleged that the defendants violated the Mental Health Parity and Addiction Equity Act of 2008 (Parity Act) through coverage denial.
The plaintiffs, a parent and a dependent, stated that UBH denied coverage of the dependent’s residential therapy treatment at Evoke Wilderness Program. The company claimed such programs are “experimental and unproven” and that the dependent was “not at risk,” of self-harm or harm to others, “was medically stable, was not experiencing withdrawal symptoms, was not under the care of a psychiatrist, and did not require 24-hour medical or psychiatric care,” the court explained. After the wilderness program, the dependent was admitted to Catalyst Residential Treatment, which the plaintiffs cla
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December 21, 2020
In the Northern District of California on Friday, Judge Yvonne Gonzalez Rogers dismissed health insurance case against United Behavioral Health was dismissed with leave to amend. The judge dismissed the plaintiffs’ claims with prejudice under the Sherman Act and Racketeer Influenced and Corrupt Organizations Act (RICO) and the plaintiffs’ state law claims within the scope of the Employee Retirement Income Security Act (ERISA). Furthermore, the judge dismissed the plaintiffs’ state law claims regarding plans that fall outside the scope of ERISA with leave to amend.
The plaintiffs, led by Pacific Recovery Solutions, are out-of-network health care providers who provided intensive outpatient program (IOP) services to patients who had health insurance policies administered by United. At dispute was whether United represented to the plaintiffs that it would pay a percentage of the Usual, Customary, and Reasonable Rates (UCR) for the IOP serv
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On this week’s episode, Carla DewBerry and Sarah Carlins discuss a recent California Federal District Court decision in
David Wit v. United Behavioral Health, in which the court found that the defendant insurer violated ERISA by improperly denying behavioral health claims submitted by over fifty thousand beneficiaries. The presenters discuss the ways in which the insurer’s inadequate internal guidelines for the processing of behavioral health treatment claims led to the decision, and what this might mean for the design of behavioral health claims processing guidelines under ERISA regulated health plans in the future.
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