A young woman who was on her father’s health plan and needed mental health treatment is the lead plaintiff in a UnitedHealthcare insurance class action lawsuit alleging violations of the Employee Retirement Income Security Act and the Mental Health Parity and Addiction Equity Act of 2008.
The plaintiff allegedly needed to go to in-patient treatment for treatment of depression, an eating disorder, and related conditions and severe anxiety. She was admitted to Monte Nido Vista in California, licensed by the state as a residential treatment facility. However, the doctor reviewing her claim decided that “she is not a serious risk of harm to herself or others. Her weight is appropriate. There are no acute medical issues,” according to the UnitedHealthcare class action lawsuit.
The UnitedHealthcare class action claims that these decisions fail to provide adequate benefits on two levels. One, the concerns that the doctor raised in the insurance claim denial are not for residential treatment which is less intensive, but rather for emergency care in an acute inpatient setting, which is not what the woman was requesting. Further, the requirements UnitedHealthcare maintains internally are in contradiction of naturally accepted practices.
In fact, the insurer’s “practice was to condition coverage on a [patient’s] inability to satisfy two inapplicable acute inpatient criteria.” This is unnecessary, according to the UnitedHealthcare class action lawsuit.
The other named plaintiff in the class action is a man who sought substance treatment and ran into problems regarding the coverage. However, according to the Parity Act, insurers cannot provide different benefits unless they are equivalent to those of a majority of other conditions.
The plaintiffs claim that UnitedHealthcare’s policies should provide for mental health and substance abuse treatments, even those that will require maintenance care. Instead, the insurance class action lawsuit alleges that the company applies different rules internally, resulting in inadequate benefits for people. So not only does the company attempt to use unreasonable standards for each insurance claim denial, but that they also do not match currently accepted medical opinion.
The plaintiffs are represented by class action attorneys Meiram Bendat of Psych-Appeal Inc., by D. Brian Hufford and Jason S. Cowart of Zuckerman Spaeder LLP and Anthony F. Maul of the Maul Firm PC.
The UnitedHealthcare Insurance Class Action Lawsuit is David Wit, et al. v. United Healthcare Insurance Co., et al., Case No. 14-cv-02346, in the U.S. District Court for the Northern District of California.
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