A class-action lawsuit filed Nov. 4 is accusing United Behavioral Health, a branch of UnitedHealthcare, of unjustly denying mental health claims.
The lawsuit claims that United Behavioral Health denied coverage of behavioral health services to which members are allegedly entitled under UBH's "Level of Care Guidelines," which the insurer uses to evaluate medical necessity of services. The guidelines challenged by the suit are similar to those used from 2011-17, which a previous court found were "pervasively more restrictive than the generally accepted standards," according to a Nov. 5 news release from the legal team representing the plaintiffs.
The lawsuit also alleges that a policy requiring providers to "bundle" all services a patient receives in one day into a single claim is restrictive to coverage. According to the complaint, denying the bundled claim on the grounds that some care was unnecessary could also deny necessary care included in the bundle.
A UnitedHealthcare spokesperson told Becker's that the insurer will defend itself against the allegations.
"We are committed to ensuring all our members have access to care consistent with the terms of their health plan and state and federal rules — and will vigorously defend ourselves in this case," the spokesperson told Becker's. "As part of our broader commitment to quality care, we continue to support our members with increased access to providers and new ways to quickly get the effective behavioral support they need."