A U.S. district court judge Nov. 3 ordered United Behavioral Health, part of UnitedHealth Group, to reprocess close to 67,000 mental health and substance use disorder benefit claims denied over a six-year period.

The order in Wit v. UBH also includes a 10-year injunction requiring UBH to exclusively apply medical necessity criteria developed by non-profit clinical specialty associations; appointment of a special master to oversee implementation of the court’s order; and employee training in the proper use of court-ordered medical necessity criteria.

In prior rulings in the case, the court found “pervasive and long-standing violations of ERISA by [UBH]” in which “UBH denied mental health and substance use disorder treatment coverage to tens of thousands of [individuals] using internal guidelines that were inconsistent with the terms of the [individuals’] health insurance plans.”

Related News Articles

Headline
Dallas-based Parkland Health and Hospital System brings physical and behavioral health together by integrating suicide risk screenings in all patient visits,…
Blog
It is often said: healthy mind, healthy body, healthy life. At the 882-bed Parkland Health and Hospital System in Dallas, marrying physical and behavioral…
Blog
The opioid epidemic impacts all racial and ethnic groups, but attention paid to this epidemic has often neglected to include Black/African American communities…
Headline
Sejal B. Shah, M.D., and Carla B. Monteiro, a licensed clinical social worker, at Boston-based Brigham and Women’s Hospital write that stigma and disparities…
#HealthCareInnovation Thursday Blog
During the COVID-19 pandemic, opioid overdoses have skyrocketed — doubling in some places from just one year ago. Physical isolation, disruption in regular…
Headline
Hospital outpatient departments, critical access hospitals, rural health clinics and other eligible providers may apply through Jan. 3 to participate in the…