Justice and Divine Vengeance Pursuing Crime

Ruling: United Behavioral Health Illegally Denies Care

United Behavioral Health is systematically “ignoring the effective treatment of members’ underlying conditions,” says U.S. Magistrate Judge Joseph Spero. In an ongoing case, the judge issued a scathing decision against this division of United Healthcare.

This case is all about access to care for mental health and addiction. But it perfectly illustrates the playbook for denying access to care for obesity.

A Monumental Win

Patient advocates see this as a big deal. More than a decade ago, federal law required health plans to cover mental health and addiction disorders. However, insurers adapted. Instead of covering the underlying conditions, United set up systems for covering patients in crisis while ignoring chronic conditions.

The results can be devastating. For example, one plaintiff told the court that her son died after the insurer refused to cover his need for ongoing treatment. The judge ruled that United’s actions were unreasonable and abusive. He wrote that testimony by company experts was “evasive – and even deceptive.” Not good.

Attorneys for the plaintiffs were elated. Attorney D. Brian Hufford said:

In our view, it’s a monumental win for mental health and substance abuse patients.

United Health is ready to keep fighting against these patient advocates. The company insists that “our members received appropriate care.”

Denying Care to Save Money

What this case reveals is a methodical abuse of coverage decisions for behavioral health. In fact, the judge found a process “infected” by financial incentives to restrict needed care. Patients suffered and died. All of this is still happening a decade after specific legislation to make such conduct illegal.

So it’s no wonder that we have such a tough fight on our hands for access to obesity care. Health plans follow the same playbook. Need obesity meds? Come back and see us when your condition is bad enough to require surgery. Want behavioral therapy? We’ll cover one or two visits – even though such limited support has zero effect.

But this case also offers a bit of good news. Change comes with persistent advocacy.

Click here for more from the New York Times and here for more from law.com.

Justice and Divine Vengeance Pursuing Crime, painting by Pierre-Paul Prud’hon / WikiArt

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March 6, 2019