UnitedHealth Group to pay over $15M after mental-health coverage investigation
The Business JournalSep 02, 2021
An investigation by the
In doing so, the company was "over- charging participants" for those services, and flagged participants undergoing mental-health treatments for a utilization review, "resulting in many denials of payment for those services,"
The
United's action violated the Mental Health Parity and Addiction Equity Act of 2008. That law prohibits ERISA-covered health plans from imposing treatment limitations on mental health and substance-use disorder benefits that are "more restrictive" than the treatment limitations they impose on medical and surgical benefits.
ERISAis short for Employee Retirement Income Security Act.
Many participants and beneficiaries did not receive the mental health and substance-use benefits to which they were entitled under their ERISA-covered health plans due to United's violations,
Investigators also found United failed to disclose sufficient information about these practices to plans and their participants and beneficiaries. In the settlement, United agrees to stop the violations, improve its disclosures to plan participants, and "commit to future compliance."
"In the shadow of the most devastating year for overdose deaths and in the face of growing mental health concerns due to the pandemic, access to this care is more critical than ever before,"
In reaction,
"We are committed to ensuring all our members have access to care and to reimbursing providers consistent with the terms of the member's health plan and state and federal rules. We are pleased to resolve these issues related to business practices no longer used by the company. As part of our broader commitment to quality care, we continue to support our members with increased access to providers and new ways to get the effective behavioral support they need," the company said. ¦