Brigette Honaker  |  December 2, 2019

Category: Insurance

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A recent UnitedHealth class action lawsuit claims that the health insurance company’s subsidiary refuses to pay for autism treatment.

The mother of a 13-year-old claims that United Behavioral Health, a subsidiary of UnitedHealth Group, wrongfully refused to pay for her child’s autism treatment.

The healthcare insurance company allegedly enforces bans on applied behavior analysis – a form of autism treatment that helps patients build social skills and other applicable skills. This ban reportedly results in the company failing to provide payments under certain employee benefit plans.

The plaintiff’s teenager is covered by his father’s insurance which is allegedly provided through his employer, IT company Wipro. Wipro’s plan is reportedly run by UnitedHealth.

According to the UnitedHealth class action lawsuit, the teen’s mother – who filed the UnitedHealth class action as an anonymous plaintiff – has felt the full brunt of the health insurance company’s denial.

The 13-year-old boy was allegedly recommended applied behavior analysis treatment after he became increasingly aggressive and violent due to his autism. Although his mother tried to have the treatment covered, United Behavioral Health denied her claim.

“What’s ironic is United Behavioral Health has recognized that applied behavioral health therapy is the standard of care for autism,” plaintiff counsel said in a statement. “It even adopted a policy in 2017 to cover ABA therapy in all of its fully-insured plans. But UBH enforces exclusions of ABA coverage in self-funded plans, which represent over 70% of its business. This lawsuit will show that UBH’s behavior is both illegal and irresponsible.” 

The UnitedHealth class action lawsuit claims that UnitedHealth and United Behavioral Health violate the Mental Health Parity and Addiction Equity Act (MHPAEA) by denying applied behavioral analysis claims. 

The MHPAEA requires insurers and claims administrators to be fair when assessing claims related to mental health and addiction. Under the act, they are required to treat these claims in the same way they evaluate claims for physical problems like illness, injury, and disease.

The UnitedHealth class action claims that the company also violates the Employee Retirement Income Security Act (ERISA) by breaching their fiduciary duties.

The anonymous plaintiff seeks to represent a Class of participants or beneficiaries in UnitedHealth plans that were denied coverage based on an exclusion of coverage for intensive behavior therapies applicable solely to mental health, including applied behavioral analysis for autism treatment.

Did UnitedHealth refuse to pay for your autism treatment or the treatment of a loved one? Share your experiences in the comment section below.

Plainitffs and the proposed Class are represented by D. Brian Hufford, Jason S. Cowart, Caroline E. Reynolds and Rachel F. Cotton of Zuckerman Spaeder LLP, and Meiram Bendat of Psych-Appeal Inc.

The UnitedHealth Autism Coverage Class Action Lawsuit is Doe, et al. v. United Behavioral Health, et al., Case No. 3:19-cv-07316, in the U.S. District Court for the Northern District of California.

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2 thoughts onUnitedHealth Class Action Says Autism Treatment Should Be Covered

  1. Natasha says:

    Add me please

  2. Morgan V says:

    Add me following.. United healthcare likes to denote lord of autism necessities

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