fbpx

United Behavioral Health Guidelines and Rejected Claims Class Action

United Behavioral Health (UBH) “administers mental health and substance use disorder benefits for commercial welfare benefit plans,” says the complaint for this class action. But, according to the complaint, UBH’s guidelines for accepting or rejecting treatment under those plans have been flawed and were rejected in a previous class action. This class action seeks to extend the class period for those who want to make claims against UBH.

UBH put out its 2017 Level of Care Guidelines, intending to use them, the complaint says, “to determine whether mental health and/or substance use disorder services for which coverage was requested were consistent with generally accepted standards of care.” If it found the services not to meet such standards, it would refuse to pay for them.

Two class actions were brought against UBH and were consolidated to be tried as one case, which brought claims under the Employee Retirement Income Security Act (ERISA). 

According to the complaint, the court “found that the UBH Level of Care Guidelines in effect from 2011 through 2017 … were unreasonable and did not reflect generally accepted standards of care, and thus conflicted with the relevant terms of the … class members’ plans.” The complaint quotes the judge as saying that UBH’s guidelines were “riddled with requirements that provided for narrower coverage than is consistent with generally accepted standards of care.”

However, the class in that combined case included only those whose requests for coverage were denied by UBH between May 22, 2011 and June 1, 2017. However, UBH went on using the faulty guidelines until May 9, 2018. Although it had announced that it would discontinue using its own guidelines, it not only continued to use them for a time but issued new ones that were also flawed, the complaint says. 

According to the complaint, UBH has already been found to have breached its fiduciary duties and violated ERISA. This additional case has been brought “to ensure that all UBH members who were injured by UBH’s proven misconduct with respect to the 2017 Level of Care Guidelines … will obtain all the relief available to them under ERISA.”

The plaintiff in this case is Sandra Tomlinson, whose health plan covers mental illness and substance abuse as well as physical health problems. UBH is the behavioral health administrator for the plan and makes decisions as to which claims to pay. In that capacity, UBH rejected Tomlinson’s requests for coverage for her daughter’s residential treatment. Two appeals and an external review upheld the denial.

The class for this action is any participant or beneficiary in a health benefit plan under ERISA whose request for coverage of residential treatment services for a mental illness or substance use disorder was denied by UBH, in whole or in part, after June 2, 2017, based on UBH’s 2017 Level of Care Guidelines.

Article Type: Lawsuit
Topic: Insurance

Most Recent Case Event

United Behavioral Health Guidelines and Rejected Claims Complaint

October 25, 2019

United Behavioral Health (UBH) “administers mental health and substance use disorder benefits for commercial welfare benefit plans,” says the complaint for this class action. But, according to the complaint, UBH’s guidelines for accepting or rejecting treatment under those plans have been flawed and were rejected in a previous class action. This class action seeks to extend the class period for those who want to make claims against UBH.

Case Event History

United Behavioral Health Guidelines and Rejected Claims Complaint

October 25, 2019

United Behavioral Health (UBH) “administers mental health and substance use disorder benefits for commercial welfare benefit plans,” says the complaint for this class action. But, according to the complaint, UBH’s guidelines for accepting or rejecting treatment under those plans have been flawed and were rejected in a previous class action. This class action seeks to extend the class period for those who want to make claims against UBH.

Tags: Breach of Fiduciary Duty, Denial of Benefits, ERISA Violations, Health Insurance, Insurance