United Healthcare and Anthem Sued for Coverage Denial on Residential Treatment Claims

Two separate suits were filed in the District of Utah on Tuesday. The first health insurance suit was filed against defendants Anthem Blue Cross Life and Health Insurance Company and the Snap Inc. Benefits Plan, while the second complaint was filed against defendants United Healthcare Insurance Company, United Behavioral Health, and the Delta Pilots Medical Plan.

The suit against Anthem was brought by plaintiffs asserting that Anthem had wrongfully denied their insurance claim seeking coverage for the plaintiff’s stay at Aspiro. The plaintiff grew up experiencing Mood Dysregulation Disorder, self-harm, suicidal thoughts, anxiety, high levels of impulsivity, severe mood swings, violent outbursts, and more. After going through multiple group therapy programs as well as individualized programs, the plaintiff was admitted to Aspiro.

Aspiro is a licensed Outdoor Youth Treatment facility which “provides sub-acute inpatient treatment to adolescents with mental health, behavioral, and/or substance abuse problems.”

Anthem denied the plaintiff’s subsequent claim for the treatment at Aspiro, stating that wilderness camps were not covered in the plaintiff’s plan. The plaintiff countered this argument, stating that the plan did not provide a definition of wilderness camp, and that Aspiro was a “licensed, nationally accredited outdoor behavioral health program,” not a “adventure camp with no clinical value.” The plaintiff’s counterargument also reminded Anthem of their duties under the Mental Health Parity and Addiction Equity Act, which requires mental health services to be covered at parity with similar medical or surgical benefits. Despite the plaintiff’s appeal, Anthem reiterated its previous claims and denied payment once again.

Similarly, the suit against UBH was brought by a plaintiff who had experienced several mental health problems throughout adolescence. Specifically, the plaintiff was diagnosed with ADHD, Oppositional Defiant Disorder, Disruptive Mood Dysregulation Disorder, Unspecified Depressive Disorder, Borderline Personality Disorder, Post Traumatic Stress Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, and Anorexia Nervosa. The plaintiff experienced depression, self-harm, suicidal ideation, and more.

Throughout her childhood, the plaintiff had been through therapy, grief counseling, intensive outpatient therapy programs, and more. Eventually, the plaintiff was enrolled at Uinta, a treatment facility which also provides treatment to patients with mental health and behavioral problems. UBH denied the plaintiff’s claim for payment, citing that unproven or experimental treatment was not covered. Following multiple appeals, UBH continually upheld their denial.

Each of the complaints cites a claim for recovery of benefits as well as a violation of MHPAEA. The plaintiffs are each seeking judgment in the total amount of their medically necessary treatments, equitable relief, litigation fees, and any other relief deemed just by the Court.

For both cases, the plaintiffs are represented by Brian S. King.