If you’ve ever wondered whether your health insurer was trying to get away with not paying your insurance claims when it was legally required to, you should stop. Based on mounds of evidence, most health insurers inappropriately deny coverage for services a lot of the time. Often they get away with it. But, recently, UnitedHealth Group was fined for failing to pay for tens of thousands of mental health services their members received.
UnitedHealth Group was ordered into court-monitored supervision through a special master by a California federal judge for wrongly denying more than 67,000 mental health and substance use disorder treatment claims. The court order requires United Healthcare’s subsidiary, UBH, United Behavorial Health, to retrain its employees. It must also reprocess these claims.
One lawyer involved in the case, from PsychAppeal, made clear that UnitedHealth was not the only health insurance company guilty of this extreme misconduct. Of course not. They all tend to engage in the same behaviors. That’s how they stay competitive.
According to Violationtracker.org, UnitedHealth Group has 278 consumer-protection offenses alone in the last 20 years. For example, back in March of this year, the state of Rhode Island found UnitedHealth to be in violation of its obligations to pay for mental health and substance abuse services. It fined United Health $3.2 million for its noncompliance.
UnitedHealth Group also has been sued by a class of AT&T and CenturyLink workers, claiming that it has taken more than $1 billion each year that workers have contributed to their ERISA plans to offset money UnitedHealth owes in other unrelated plans. These offenses, along with other offenses have resulted in penalties to UnitedHealth of $603,461,164 over 20 years.
Violationtracker.org lists 25 UnitedHealth Group violations, or violations by one of its subsidiaries, that have been settled in the last two years. How many cases of fraud or misconduct have not been brought against UnitedHealth and other health insurers? Penalties are likely far smaller than the crimes, which can leave people without needed care, in medical debt or worse.
We don’t know what members of Congress think about these violations, especially those that deprive people of medically reasonable and necessary services. Here’s some food for thought: In other wealthy countries, private health insurers are not at liberty to decide for themselves when to pay claims and when to deny them. The federal government decides for them. These games can’t happen. We should urge our members of Congress to step up and protect Americans from these abuses in a similar way.
Here’s more from Just Care:
- Judge finds UnitedHealth illegally denied care to thousands
- Ten ways Medicare Advantage plans differ from traditional Medicare
- Seven reasons commercial insurance cannot meet our health care needs
- Trump administration attempts to privatize traditional Medicare
- What are Medicare premium and other costs in 2021?
…this is why we need the option of a single payer system.
The diagnosis is correct but we are increasingly distrustful of authority and therefore the treatment plan is not feasible. Bummer.
We have to keep pushing. We might not fix the problem, but there’s no chance we can succeed if we don’t keep pushing.