United Behavioral Health faces a proposed class action over its allegedly unlawful denial of coverage for certain mental health and substance abuse treatments considered to be “unproven, experimental or investigational.”
More specifically, the 14-page lawsuit alleges the insurer has violated the Mental Health Parity and Addiction Equity Act by issuing blanket denials of coverage for all mental health and substance abuse services rendered at a residential treatment center, in particular when any component of the program is considered unproven, experimental or investigational.
According to the suit, United Behavioral Health does not apply the same coverage limitations to “unproven, experimental or investigational” services that are rendered at skilled nursing facilities. Per the case, skilled nursing facilities and rehabilitation hospitals are considered “comparable” to residential treatment centers under the Parity Act, which prohibits health plans that offer mental health treatment coverage from limiting such more than medical and surgical benefits also offered under the plan.
“This disparate treatment in comparable services violates the federal Parity Act,” the complaint alleges.
The lawsuit was filed by a pseudonymous plaintiff whose minor son was covered under a United Behavioral Health insurance plan sponsored by the man’s employer, General Electric Company. Per the suit, the plaintiff’s son received mental health and substance abuse treatment at an Arizona-licensed long-term residential treatment facility over the course of 10 months, for which the plaintiff was charged $66,800. The lawsuit claims the defendant denied the plaintiff’s claim for coverage because one aspect of the center’s program, equine therapy, was “considered unproven” and therefore not covered under the man’s health insurance plan.
The case contends that United Behavioral Health’s denial of the plaintiff’s entire claim because one aspect of his son’s treatment was considered by the claims administrator to be unproven, experimental or investigational violates the Parity Act given the defendant does not apply the same coverage exclusions to medical and surgical benefits. According to the lawsuit, when certain programming at skilled nursing and rehabilitation facilities is considered to be unproven, the defendant excludes those services from coverage but “does not take the position that inclusion of those services voids all coverage obligations for services incurred at skilled nursing facilities and rehabilitation hospitals – just the services found to be unproven.”
“This coverage approach is not in parity with how Defendant covers unproven, experimental or investigational programming in comparable settings,” the complaint argues, claiming the defendant’s exclusion of mental health and substance abuse treatment from coverage is a “standardized practice.”
The lawsuit looks to represent anyone covered under an ERISA-governed healthcare plan administered or insured by United Behavioral Health whose requests for coverage for mental health and substance abuse treatment services rendered at a licensed residential treatment facility were denied in total based on the defendant’s determination that a component of the services is considered experimental, investigational or unproven.
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