United HealthCare Motion Denied in Reimbursement Rates Class Action
The U.S. District Court for the Northern District of California has denied a motion by United HealthCare to dismiss a class-action lawsuit over disparate reimbursement rates for psychotherapy services.
The class action, filed by Psych-Appeal and Zuckerman Spaeder LLP, alleges that United HealthCare Insurance Co. (“UHIC”) and United Behavioral Health (together “United”) have violated mental health parity laws by imposing arbitrary reimbursement penalties on psychotherapy services provided by psychologists and master’s level counselors.
The plaintiff in this case alleges that United has a policy in place that reduces the “allowed amount” of covered charges for out-of-network services by 25 percent for services provided by a psychologist and by 35 percent for services provided by a master’s level counselor (i.e., an LCSW). As a result, anyone receiving psychotherapy services from a psychologist or social worker is subject to reduced reimbursement rates by United HealthCare. The plaintiff argues that these arbitrary reimbursement penalties violate the Federal Parity Act and the Affordable Care Act by discriminating against patients seeking behavioral health services from such providers.
In its decision, the court ruled that the plaintiff has a plausible claim under the Parity Act and that the plaintiff did not need to identify comparable medical benefits to the mental health/substance use disorder benefits in dispute.
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