As a medical insured with United Health, I have been very happy with my coverage for the last year. Basically, I have had no problems with them and I love the coverage with multiple gyms for workouts.

After about one year, I have received repeat phone calls from the company requesting time for a ‘wellness exam.” At first I told them I already had a regular doctor and got this exam from her each year. Not to be deterred, the phone calls kept coming and coming. Finally, I agreed to have a nurse come to my place for a wellness exam.

The date of the exam, I made sure to be there on time and have cold water in the fridge in case someone needed some. The nurse showed up with a sidekick, another nurse in training. The exam took an hour and included my weight, bloodpressure and heart. In addition, was a cognitive test for my memory. All of these items were stock in trade and usual for all exams I get at the clinic. The disturbing part came with the long, long list of deep and probing questions about my entire health history to include information about mother, father, brothers and sisters. I answered the questions. The question went on about drugs and alcohol for myself and all family members. I had to answer questions about all surgeries and injuries that I had had in the last year. I discussed two recent surgeries that were for arthritis. The nurse got practically excited when I admitted to smoking cigarettes 30 years ago. She wanted me to tell her how many cigarettes I smoked per day. I laughed at this point and said I couldn’t remember that far back but it was only ‘occasional, social smoking.’ More questions followed, I had my temperature taken and got measured for height and my BMI was calculated. I had to have a pressure test to the bottoms of my feet to check for nerve damage. The digging kept on about depression, mental illness, treatment for psychological problems. The nurse was very nervous when she showed up.

After giving her negative answers to most of these questions and we found that my BMI was low enought, blood pressure low enough and heart ok, the nurse seemed to relax. By the time the pair left I realized that I had been subjected not to a wellness exam, it was a disqualifing exam. This was an intensive investigation to see if the company had a basis for cancelling my coverage. I was shocked when it all sank in. I await the results of my exam. Hopefully I passed. However, next year, my response will be that they can get copies of my records from my GP. What an invasive and demeaning experience. And, how many people have to go through this.? God forbid I had anything serious wrong with me, short of age, of course. Wow! I can’t talk to family members about this as they are all military and have life long coverage. Review the next.

https://apnews.com/press-release/globe-newswire/business-health-7ac8e3da7f47c4064e7c49d28b82db4c

U.S. Federal Court Finds UnitedHealthcare Affiliate Illegally Denied Mental Health and Substance Use Coverage in Nationwide Class Action

BY INC., PSYCH-APPEALPublished 10:47 AM MST, March 5, 2019Share

— Landmark Case Challenges the Nation’s Largest Mental Health Insurance Company for Unlawful, Systematic Claims Denials – and Wins — Groundbreaking Ruling Affects Certified Classes of Tens of Thousands of Patients, Including Thousands of Children and Teenagers — Judge Rules, “At every level of care that is at issue in this case, there is an excessive emphasis on addressing acute symptoms and stabilizing crises while ignoring the effective treatment of members’ underlying conditions.”

LOS ANGELES, March 05, 2019 (GLOBE NEWSWIRE) — In a landmark mental health ruling, a federal court held today that health insurance giant United Behavioral Health (UBH), which serves over 60 million members and is owned by UnitedHealth Group, used flawed internal guidelines to unlawfully deny mental health and substance use treatment for its insureds across the United States. The historic class action was filed by Psych-Appeal, Inc. and Zuckerman Spaeder LLP, and litigated in the U.S. District Court for the Northern District of California.

The federal court found that, to promote its own bottom line, UBH denied claims based on internally developed medical necessity criteria that were far more restrictive than generally accepted standards for behavioral health care. Specifically, the court found that UBH’s criteria were skewed to cover “acute” treatment, which is short-term or crisis-focused, and disregarded chronic or complex mental health conditions that often require ongoing care.

The court was particularly troubled by UBH’s lack of coverage criteria for children and adolescents, estimated to number in the thousands in the certified classes.

“For far too long, patients and their families have been stretched to the breaking point, both financially and emotionally, as they battle with insurers for the mental health coverage promised by their health plans,” said Meiram Bendat of Psych-Appeal, Inc. and co-counsel for the plaintiffs who uncovered the guideline flaws. “Now a court has ruled that denying coverage based on defective medical necessity criteria is illegal.”

In its decision, the court also held that UBH misled regulators about its guidelines being consistent with the American Society of Addiction Medicine (ASAM) criteria, which insurers must use in Connecticut, Illinois and Rhode Island. Additionally, the court found that UBH failed to apply Texas-mandated substance use criteria for at least a portion of the class period.

While the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 requires parity for mental health and substance use benefits, insurers are permitted to evaluate claims for medical necessity. However, by using flawed medical necessity criteria, insurers can circumvent parity in favor of financial considerations and prevent patients from receiving the type and amount of care they actually require.

In his decision, Chief Magistrate Judge Joseph Spero concluded that “the record is replete with evidence that UBH’s Guidelines were viewed as an important tool for meeting utilization management targets, ‘mitigating’ the impact of the 2008 Parity Act, and keeping ‘benex’ [benefit expense] down.”

Psych-Appeal, Inc. and Zuckerman Spaeder LLP were appointed class counsel by the federal court and represent plaintiffs in several class actions against other insurers.

For more information, visit www.psych-appeal.com.

Contact: Chantal Allan (310) 598-3690 x.201|callan@psych-appeal.com