A class-action lawsuit was filed on October 16, 2018 against United HealthCare Insurance Co. and United Behavioral Health claiming that they have systematically violated the legal duties owed to plan participants by imposing arbitrary reimbursement penalties on psychotherapy rendered by psychologists and master’s level counselors. The plaintiff alleges that the defendants have a policy in place that reduces the “eligible expense” of covered charges by 25 percent when provided by a psychologist and 35 percent when provided by a master’s level counselor, such as a Licensed Clinical Social Worker (LCSW). As a result, anyone receiving psychotherapy services from a psychologist or social worker is subject to reduced reimbursements.
The plaintiff disputed the amount United would pay for her covered treatment for her post-traumatic stress disorder, which included individual counseling from a LCSW with post-graduate training who was considered out-of-network and therefore benefits were determined based on an “eligible expense,” which is the maximum amount eligible for reimbursement. The plaintiff argues that these arbitrary reimbursement penalties violate the Federal Parity Act and the Affordable Care Act by discriminating against certain behavioral health providers and patients.
The plaintiff’s lead class-action counsel stated at the time of filing the class-action complaint, “We believe United is clearly violating its duty to plan holders by imposing arbitrary reimbursement penalties. Through these penalties, United is devaluing psychotherapy and is ultimately limiting access to an essential health benefit that plays a critical role in addressing pervasive public health issues, such as mental health and substance abuse disorders.”
The plaintiff’s co-counsel stated: “We have seen the data from NIH – that 26 percent of American adults suffer from some type of mental health condition each year – and that outpatient psychotherapy is crucial to the ongoing treatment and recovery for those who suffer from these conditions. Yet we still see examples like this one, of private insurance companies taking steps to systematically deny or diminish mental health benefits to plan holders. We continue to fight to hold insurers accountable for this kind of discriminatory behavior.”
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