$14.4 million: UnitedHealth Group settles charges of illegally denying coverage to patients

pharmafile | August 13, 2021 | News story | Medical Communications  

The largest US health insurer, UnitedHealth Group, has settles federal and New York state charges of illegally denying coverage to patients with mental health issues and substance abuse.

Authorities accused UnitedHealth of violating federal and state laws by imposing more restrictive limits on coverage and treatment for mental health and substance abuse disorders than it imposed for physical health conditions.

UnitedHealth was also accused of overcharging patients for out-of-network mental health services by reducing reimbursements.

As a result of these agreements, United will pay approximately $14.3 million in restitution to consumers affected by the policies, including $9 million to more than 20,000 New Yorkers with behavioural health conditions who received denials or reductions in reimbursement.

New York and federal law requires health insurance plans to cover mental health and substance use disorder treatment the same way they cover physical health treatment. The agreements — which resolve investigations and litigation — address United’s policies that illegally limited coverage of outpatient psychotherapy, hindering access to these vital services for hundreds of thousands of New Yorkers for whom United administers behavioural health benefits.

In addition to the payment to impacted consumers, United will lift the barriers it imposed and pay more than $2 million in penalties, with $1.3 million going to New York state. 

New York Attorney General Letitia James said: “In the shadow of the most devastating year for overdose deaths and in the face of growing mental health concerns due to the pandemic, access to this care is more critical than ever before.

“United’s denial of these vital services was both unlawful and dangerous — putting millions in harm’s way during the darkest of times. There must be no barrier for New Yorkers seeking health care of any kind, which is why I will always fight to protect and expand it.”

Without admitting liability, UnitedHealth agreed to stop using algorithms, including in a programme called ALERT, that required extra layers of review before continuing mental health treatment and often resulted in coverage being cut off.

UnitedHealth, based in Minnetonka, Minnesota, said in a statement it was pleased to settle, and no longer used the challenged practices, including ALERT.

It also said it was committed to providing care, including “behavioural support,” and reimbursement to policyholders consistent with federal and state rules.

Kat Jenkins

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