$13.6M Paid By United Healthcare For Denying Mental Health Care In NY

NEW YORK — The nation's largest health insurer has paid millions to patients in New York whose claims were unfairly denied.

NY Attorney General Letitia James announced on Friday that $13.6 million has been paid to New Yorkers who had been denied health care coverage under an August 2021 agreement with United Healthcare.

The agreement was the result of a federal lawsuit against United for illegally denying coverage of outpatient psychotherapy for thousands of members. Of the $13.6 million for patients across the U.S., almost $8 million went to more than 20,000 New Yorkers who received denials or reductions in reimbursement for behavioral health conditions. United also paid $725,000 directly to consumers who had been impacted.

"I am proud to have recovered millions of dollars for New Yorkers who were denied access to mental health care," James said. "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."

Both NYS and federal law require health insurance plans to cover mental health and substance use disorder treatment in 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In August 2021, Attorney General James sued United under New York’s behavioral health parity law (originally enacted as “Timothy’s Law” in 2006) and the federal Mental Health Parity and Addiction Equity Act of 2008. The U.S. Department of Labor simultaneously filed a similar complaint. Both alleged practices by United that violated behavioral health parity laws by restricting psychotherapy coverage.

Through its "reimbursement penalty," United had reduced reimbursement to members who had undergone psychotherapy provided by PhD-level psychologists and masters-level therapists, who are in fact the predominant providers of this treatment. Under its Algorithms for Effective Reporting and Treatment (ALERT) program, United had also set arbitrary thresholds to trigger reviews of psychotherapy, which often resulted in denial of coverage.

$6 million in restitution payments were recently made 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 York residents affected by the ALERT program.

If any United members believe 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 them here, or visiting the website for additional information.

SEE ALSO: Montefiore Reaches Deal To Again Accept United Health Insurance