Wit v. UBH Update: New Finding Supports Plaintiffs

A federal judge has issued additional findings of fact and conclusions of law in Wit v. United Behavioral Health (Wit v. UBH). In his decision, Judge Joseph Spero ruled that coverage determination guidelines (CDGs) used by United Behavioral Health (UBH) over a six-year period were illegal because the guidelines incorporated UBH’s level of care guidelines (LOCGs), which were previously found by the court to have been inconsistent with generally accepted standards of care.

In his decision, Judge Spero wrote that because the CDGs “…incorporate UBH’s LOCGs, which the Court has found to be more restrictive than generally accepted standards of care, UBH’s use of these CDGs to make benefits determinations was wrongful for the same reasons its use of the LOCGs was wrongful.”

The court further found that for many of the coverage determination guidelines, “the vast majority of them contain not just one of the categories of incorporating language described above but multiple categories of language incorporating the LOCGs.”

Wit v. United Behavioral Health made international headlines in March 2019, when Judge Spero ruled that UBH developed and applied overly restrictive guidelines to deny more than 50,000 mental health care claims. The decision represented a milestone since UBH is the behavioral health claims administrator for UnitedHealth Group, the nation’s largest insurer and No. 6 on the Fortune 500 list of companies.

The historic decision also found that UBH misled regulators about its guidelines being consistent with the American Society of Addiction Medicine (ASAM) criteria, which insurers must use in certain states, including Connecticut, Illinois, and Rhode Island.

The case now referred to as “Wit v. UBH” is actually two consolidated class-action lawsuits – Wit et al. v. United Behavioral Health and Alexander et al. v. United Behavioral Health – that were brought under the Employee Retirement Income Security Act of 1974 (ERISA) in 2014, certified in 2016, and tried in October 2017. Decisions pertaining to this class action affect UBH insureds who were denied outpatient, intensive outpatient, and residential treatment from 2011 to 2017. Only ERISA participants and beneficiaries are class members in this lawsuit.

A ruling on remedies is expected this fall.

Today’s order can be accessed here.

The March 5, 2019, decision can be found here.