Zuckerman Spaeder Sues UnitedHealth for Denying Teenage Girl’s Potentially Life-Saving Behavioral Health Treatment
Zuckerman Spaeder has brought a lawsuit against United Behavioral Health (UBH). According to the Complaint, UBH and its parent company UnitedHealth violated their fiduciary obligations under ERISA by denying residential behavioral health treatment to a teenage girl. The potentially life-saving treatment was deemed particularly critical by her doctors because the COVID pandemic made other treatment options even less effective than they would have been.
The girl, who suffers from a severe eating disorder and treatment-resistant major depressive disorder, was re-admitted to a California residential treatment center in mid-March 2020. According to the lawsuit, in early April her doctors discussed discharging her to a Partial Hospitalization Program (PHP) but decided that doing so would “not provide an adequate level of care. The only available PHP was being conducted remotely due to the COVID-19 pandemic. The providers concluded that stepping [her] down to PHP would be inappropriate because, ‘due [to] risk to self, [she] cannot be home at this time.’”
Despite the clear medical direction from the girl’s medical providers, UBH denied her coverage for residential treatment from April 6 onward. This forced her family to pay tens of thousands of dollars out-of-pocket in order to keep her in residential treatment where she could receive the care needed to protect her health and life.
The lawsuit, filed on the girl’s behalf by her father, argues that UBH was required to cover the residential treatment because it was deemed medically necessary by her health providers. Instead, UBH denied her claim using a “grossly deficient and biased application” of the appropriate medical necessity standard, and thereby violated the terms of her ERISA-governed health insurance plan and breached its duties as a fiduciary of the plan.
The lawsuit is part of Zuckerman Spaeder’s national effort to hold health insurers accountable for wrongful behavioral health claim denials. Under the leadership of D. Brian Hufford, Jason Cowart, and Caroline Reynolds, the firm has brought numerous lawsuits against United and other insurers for treatment denials related to major depressive disorder, eating disorders, autism, and more. This most recent case is being led by partner Aitan Goelman, with Psych-Appeal serving as co-counsel. It was filed in U.S. District Court for the Northern District of California on June 22, 2020.