CNN reports that UnitedHealth was found to have illegally denied care to thousands of its members. Policymakers in Washington should take note of the risk commercial health insurers may pose to Americans and question their viability. Why do the politicians behave as if they are fenced in?
Judge Spiro of the US District Court for the Northern District of California has yet to set the punishment. What is clear, however, is that UnitedHealth—the largest mental health insurer—established mental health coverage guidelines that wrongfully and systematically denied its enrollees benefits to which they were entitled. It illegally denied its enrollees access to needed care–in this case, mental health care. The judge also found that UnitedHealth’s medical directors were misleading in their sworn testimony.
Most important, the judge found that UnitedHealth focused on cost-cutting over appropriate treatment. Cost-cutting through wrongful delays and denials of care appears to be widespread in commercial health plans. See this report from the Government Accountability Office.
If United Health’s medical directors are wrongly denying mental health care, isn’t it reasonable to assume that its medical directors are wrongly denying other needed care? There’s good reason to believe that the wrongful denials affect not only the 50,000 enrollees needing mental health care but the hundreds of thousands of enrollees needing other care.
United Health’s medical directors are supposed to adhere to particular effective treatment guidelines for people with mental health issues. They did not. As a result, these patients received a lower level of care than appropriate, putting them at risk of worse health outcomes.
Now, UnitedHealth and other commercial insurers are trying to keep CMS from getting more patient encounter data from people enrolled in their Medicare Advantage plans. This data could help show whether enrollees are getting needed care or going without it. So, naturally, the insurers want to keep it from government scrutiny. Taxpayer dollars pay for this care; the public should be able to see what it is paying for.
The lack of accountability in the commercial health insurance system is untenable. It’s one of the key reasons that we pay more for our health care and get poorer health outcomes than people in other wealthy countries with government-administered health care, We need Medicare for All.
If you want Congress to pass Medicare for All, please sign this petition.
Here’s more from Just Care:
- People with serious health needs more likely to disenroll from Medicare Advantage plans
- Inappropriate Medicare Advantage care denials appear widespread
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Ten ways Medicare Advantage plans differ from traditional Medicare
- Free and low-cost ways to address hearing loss