UnitedHealthcare Unlawfully Denied Coverage to 20,000 New Yorkers for Mental Health and Substance Abuse Treatment
New York Attorney General Letitia James today announced the completion of $13.6 million in payments to consumers who were denied health care coverage under her landmark agreement with UnitedHealthcare, the nation’s largest health insurer. The payments are a result of an agreement that Attorney General James reached in August 2021 that resolves her federal lawsuit against United for illegally denying coverage of outpatient psychotherapy for thousands of members. This month, the settlement administrator concluded payments totaling $13.6 million for patients across the country, with almost $8 million to more than 20,000 New Yorkers with behavioral health conditions who received denials or reductions in reimbursement. In connection with the 2021 agreement, United also paid $725,000 directly to consumers who had been impacted by United’s illegal practices.
“I am proud to have recovered millions of dollars for New Yorkers who were denied access to mental health care,” said Attorney General James. “In this time of extreme stress, devastation, and pain, we must ensure more care — not less — for those seeking the help they need. I will always work to tear down the barriers to health care established by insurance companies and hold these companies accountable for failing our communities.”
New York and federal law requires health insurance plans to cover mental health and substance use disorder treatment the same way they cover physical health treatment. In August 2021, Attorney General James sued United under New York’s behavioral health parity law (originally enacted as “Timothy’s Law” in 2006) and the federal Mental Health Parity and Addiction Equity Act of 2008. Attorney General James’ complaint parallels a complaint filed concurrently by the U.S. Department of Labor (USDOL) describing two practices by United that the agencies allege violated behavioral health parity laws by improperly restricting coverage of psychotherapy. Under the “reimbursement penalty,” United had reduced reimbursement to members for psychotherapy provided by PhD-level psychologists and masters-level therapists, who are the predominant providers of this vital treatment. Additionally, under its Algorithms for Effective Reporting and Treatment (ALERT) program, United had set arbitrary thresholds to trigger reviews of psychotherapy, which often led to denials of coverage.
A total of $6 million in restitution payments were made this month to more than 11,000 New Yorkers affected by the “reimbursement penalty.” $1.6 million in restitution payments were previously made to more than 1,600 New Yorkers affected by the ALERT program.
If a consumer believes they have not received the restitution payments they are owed or have questions about the settlement, they can contact the Settlement Administrator by calling 1-866-590-8527, emailing firstname.lastname@example.org, or visiting the website to learn more.