Court Rules UnitedHealth Breached Duty to Patients Via Restrictive Coverage Policies
Last week, a federal judge ruled that
The ruling stems from a class action lawsuit brought on behalf of approximately 50,000 patients who were denied coverage for residential mental health and substance use disorder treatment. Under federal law, self-insured health plans are obligated to administer health plan benefits "solely in the interest of the participants and beneficiaries . . . [and with] care, skill, prudence, and diligence."
The court found that determining coverage using criteria that deviated from established standards of care violated the fiduciary duty that was owed to patients.
At issue in the recently decided case, Wit v.
This "overemphasis on acuity," the court ruled, resulted in inappropriate denials of coverage for patients and violated federal law. Although federal and state law generally require health plans to provide mental health and substance use disorder benefits at levels equal to other medical or surgical benefits, patients continue to struggle to obtain coverage for treatment of mental health and substance use disorders. This decision, if upheld on appeal, could provide a legal avenue for patients to ensure that they receive adequate coverage for treatment of mental health and substance use disorders.
Senator Tammy Baldwin Introduces Reform to Protect Health Care and Social Services Workers From Workplace Violence
Two Volvo SUVs Qualify for 2019 IIHS Safety Awards
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News