US Chief Magistrate Judge Joseph Spero issued his decision Tuesday against United Behavioral Health, a unit of UnitedHealthcare, saying the insurer created internal policies that effectively discriminated against those seeking mental health and substance abuse treatment. Legal observers called the decision one of the most important and most thorough rulings ever issued against an insurance company, at the federal level, on mental health issues. The class-action suit was brought on behalf of more than 50,000 people denied coverage by United Behavioral Health, the country’s largest managed behavioral health care organization. Spero took more than a year to issue his 106-page decision. In addition to finding federal violations, Spero ruled that United Behavioral Health violated state laws in Illinois, Connecticut, Rhode Island and Texas. The judge said such decisions had real impacts on patients because United Behavioral Health ignored “effective treatment of members’ underlying condition” and that “UBH knowingly and purposefully drafted its Guidelines to limit coverage to acute signs and symptoms.” He concluded by saying one of the driving factors for such policy decisions was the company’s profit motivations: “Finally, the evidence at trial established that the emphasis on cost-cutting that was embedded in UBH’s Guideline development process actually tainted the process, causing UBH to make decisions about Guidelines based as much or more on its own bottom line as on the interests of the plan members.” (from Crains Chicago Business, March 2019)
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