United Behavioral Health, United Healthcare Insurance Co. plans to pay $15.6M, take corrective actions after federal, state investigations

NEW YORK – United Behavioral Health and United Healthcare Insurance Co. will pay $13.6 million to affected participants and beneficiaries; pay $2,084,249 in penalties; and take other corrective actions following investigations and litigation by the U.S. Department of Labor and the New York State Attorney General.

An investigation by the department’s Employee Benefits Security Administration found that – going back to at least 2013 – United reduced reimbursement rates for out-of-network mental health services, thereby overcharging participants for those services, and flagged participants undergoing mental health treatments for a utilization review, resulting in many denials of payment for those services.

United’s action violated the Mental Health Parity and Addiction Equity Act of 2008, which prohibits Employee Retirement Income Security Act-covered health plans from imposing treatment limitations on mental health and substance use disorder benefits that are more restrictive than the treatment limitations they impose on medical and surgical benefits.

Many participants and beneficiaries did not receive the mental health and substance use benefits to which they were entitled under their ERISA-covered health plans due to United’s violations. Investigators also found United failed to disclose sufficient information about these practices to plans and their participants and beneficiaries. In the settlement, United agrees to cease the violations, improve its disclosures to plan participants and commit to future compliance.

“Protecting access to mental health and substance use disorder treatment is a priority for the Department of Labor and something I believe in strongly as a person in long-term recovery,” said U.S. Secretary of Labor Marty Walsh. “This settlement provides compensation for many people who were denied full benefits and equitable treatment. We appreciate Attorney General Letitia James and her office’s partnership in investigating, identifying and remedying these violations.”

“The Department of Labor is committed to ensuring equal treatment and opportunity under the law. We are pleased to work together with our partners in the Attorney General’s Office and congratulate them on their significant contributions to litigating and settling this important case,” said Solicitor of Labor Seema Nanda.

“Plans and insurance companies cannot place special hurdles in the paths of workers and their families when they seek mental health and substance use disorder benefits,” said Acting Assistant Secretary for Employee Benefits Security Ali Khawar. “The law requires parity between these benefits and medical benefits. We are committed to vigorously enforcing the law’s requirement and making sure workers in need of help are treated fairly. The agency has also created a self-compliance tool that plans and insurance companies can use to meet the law’s requirements.” 

“In the shadow of the most devastating year for overdose deaths and in the face of growing mental health concerns due to the pandemic, access to this care is more critical than ever before,” said New York Attorney General Letitia James. “United’s denial of these vital services was both unlawful and dangerous – putting millions in harm’s way during the darkest of times. There must be no barrier for New Yorkers seeking health care of any kind, and I will always fight to protect and expand it. I thank Secretary Walsh for his partnership on this important matter.”

EBSA’s New York regional office conducted the department’s investigation. Trial Attorney Rosemary Almonte of the department’s regional Office of the Solicitor in New York negotiated the settlement for the department.

Employers and workers can reach EBSA toll-free at 866-444-3272 for help with problems related to private sector retirement and health plans. Learn more about EBSA.