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UnitedHealth to Pay $14.3M in 'Landmark' Settlement Over Mental Health Parity Law

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In what’s being touted as “landmark” settlement agreements coming from the first joint state-federal enforcement of mental health parity laws, United Healthcare will pay $14.3 million in restitution to insurance consumers nationwide who were denied or given reduced coverage for mental health and substance use disorder treatments, according to state New York Attorney General Letitia James.

Both New York and federal behavioral-health parity laws underpinning the federal suit that has led to the settlement require coverage for mental health and substance use disorder treatments to be no more restrictive than coverage for physical health issues, according to both court documents and a news release from James’ office announcing the United Healthcare settlements.

Related: Judge Orders UnitedHealth to Reprocess 67k Rejected Mental Health Claims

The restitution payments agreed to by United, the nation’s largest health insurer, will include $9 million to be paid to more than 20,000 New York residents who received denials or reductions in reimbursement from the company for outpatient treatment of behavioral health conditions, according to  James.

In addition to the payments, United will end internal policies that had created a disparity for health coverage between those receiving more traditional medical and surgical treatments and those psychotherapy-type behavioral treatments, the Attorney General’s Office’s release noted.

“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,” said James in a statement. “United’s denial of these vital services was both unlawful and dangerous—putting millions in harm’s way during the darkest of times.”

In an emailed statement on Tuesday, United Healthcare spokesman Bryan Fisher said, “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,” Fisher also said, before adding that “we continue to support our members with increased access to providers and new ways to get the effective behavioral support they need.”

The announcement from James addressed, and provided a link to, a stipulation of settlement among United Healthcare-related entities and Attorney General James and among United Healthcare-related entities and Department of Labor Secretary Martin Walsh.

The Attorney General’s Office’s Health Care Bureau and the federal labor department’s joint action lodged in the U.S. District Court for the Eastern District of New York had claimed United had been for years — in some instances since 2013 — violated both New York behavioral health parity law, originally enacted as “Timothy’s Law” in 2006, and the federal Mental Health Parity and Addiction Equity Act of 2008, according to James’ release.

The stipulation of settlement is dated Aug. 11.

James’ news release and court documents claimed United used two methods to deny or restrict coverage for insureds getting out-of-network psychotherapy treatment.

In one practice, the company would allegedly make insureds pay more for psychotherapy with non-physicians, by reducing allowed reimbursement amounts by 25% for services provided by Ph.D.-level psychologists and by 35% for master’s degree-level therapists.

“This violated parity laws because United applied these reductions to psychotherapy across the board, but for medical treatments it applied similar restrictions only in limited circumstances,” the release said.

In another practice, United would use arbitrary thresholds to trigger review of psychotherapy, often leading to coverage denials when providers couldn’t provide more patient treatment after 20 sessions.

“United subjected all outpatient behavioral health psychotherapy to outlier management, but it employed this treatment limitation only to a handful of medical/surgical services,” said the Attorney General’s Office in the release.

This New York portion of the suit was handled by state Assistant Attorney General Michael Reisman of the Health Care Bureau, which is overseen by Deputy Bureau Chief Leslieann Cachola, the release said.