Federal judge orders relief for patients with mental health and SUDs

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.”