UnitedHealthcare Sued Over Mental Health Coverage Amid Pandemic

UnitedHealthcare Insurance Co. and United Behavioral Health were sued in California federal court by a family who says the insurers wrongly refused to pay for their teenage daughter’s residential eating disorder treatment at a time when less intensive treatment options were unworkable because of the COVID-19 health crisis.

In the lawsuit, filed Monday under a pseudonym in the U.S. District Court for the Northern District of California, the teenager’s father claims she was re-admitted to a California residential treatment facility in March after her anorexia and depression worsened. Her doctors later discussed discharging her to a partial hospitalization program, but her family opted to keep her at the residential facility because the only available partial hospitalization programs were being conducted remotely because of the pandemic.

According to the family, the insurers wrongly concluded that further residential treatment wasn’t medically necessary because the teenager could be appropriately treated through a partial hospitalization program. But this conclusion was based on flawed medical necessity criteria and a failure to recognize that the online-only partial hospitalization programs available during the pandemic “equated to a significantly less intensive level of care than PHP is ordinarily intended to provide,” the family said.

UnitedHealthcare declined to comment on the lawsuit but defended its handling of mental health care benefits.

“While we cannot comment on active litigation, United Behavioral Health is committed to ensuring members have ready access to clinically effective mental health and substance use disorder treatment and support when they need it, as part of our broad commitment to accessible, quality care,” Maria Gordon Shydlo, communications director for UnitedHealthcare, told Bloomberg Law in an email.

Causes of Action: Wrongfully denied benefits under the Employee Retirement Income Security Act, declaration of future benefits.

Relief: Award of past-due benefits, equitable relief, attorneys’ fees, and costs.

Attorneys: Psych-Appeal Inc. and Zuckerman Spaeder LLP represent the family.

The case is Brown v. United Behavioral Health, N.D. Cal., No. 3:20-cv-04129, complaint 6/22/20.