"Tainted" Coverage

Posted on March 20, 2019

I was not surprised to read about the recent U.S. District Court ruling against United Behavioral Health. I was only surprised that it took so long. Over ten years before, our family had battled the Minnesota-based United Health Group subsidiary giant to gain cover for our son who has a serious mental illness. Only after I pointed out their own specific coverage guidelines and asked just who would be covered by them if not our son and the condition he was in and threatened to appeal to the Minnesota Attorney General did they relent. Undoubtedly it helped that I was a state representative and that I knew the current AG who was aggressively hounding insurance companies for better coverage of things like mental health.

The Northern California District Court Judge ruled in the class-action lawsuit earlier this month that United Behavioral Health breached their fiduciary duty by adopting coverage guidelines that did not reflect general standards of care. He said their decisions were “tainted by UBH’s financial interests.” Guidelines placed excessive emphasis on addressing acute symptoms rather than treating underlying conditions. The next court proceedings will address remedies.

Hopefully this ruling will serve notice to other insurance companies. United is far from the only one seeking to add to their bottom line by denying mental health claims.

Advocates like me who are for mental health parity rightly applauded the ruling. Former U.S. Representative Patrick J. Kennedy, the national mental health parity leader, called this a turning point in holding insurers accountable for discriminating against those with mental health and addiction challenges. In his book “A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction,” Kennedy was one of the first to nail this behavior when he said that we need to stop talking about stigma and call it what it is, discrimination.