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Case: Health & Welfare Benefits/Eating Disorder Treatment (N.D. Cal.)

Nov. 20, 2020, 10:13 PM

Unitedhealthcare Insurance Co. must pay more than $150,000 in medical expenses and interest for a four-month stay at a residential treatment facility for severe eating disorders, the U.S. District Court for the Northern District of California held. This is less than the full $208,250 billed by the facility because, the court said, the request to pay the entire amount is inconsistent with ERISA’s provision for recovery of benefits due under the terms of the applicable plan. The plaintiff failed to show that UnitedHealth would’ve paid the full amount billed by the out-of-network provider under the terms of the plan, the ...

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