How UnitedHealth’s Playbook for Limiting Mental Health Coverage Puts Countless Americans’ Treatment at Risk
Reporting Highlights
- An Insurer Sanctioned: Three states found United’s algorithmic system to limit mental health coverage illegal; when they fought it, the insurer agreed to restrict it.
- A Patchwork Problem: The company is policing mental health care with arbitrary thresholds and cost-driven targets, highlighting a key flaw in the U.S. regulatory structure.
- United’s Playbook Revealed: The poorest and most vulnerable patients are now most at risk of losing mental health care coverage as United targets them for cost savings.
An article from a month ago about United Heathcares problematic coverage, which I believe is relevant again.
The part that immediately got me was the clinician hiring a biller to dispute the $20k payback, only for it to be reduced to $10k. They probably paid the biller almost $10k to get the documentation together. For smaller paybacks, the clinic would probably be taking a loss to dispute the charge even if it gets stopped completely. As long as the insurer can provide justification for the charge, there’s basically no way to punish them for doing this, even when the insurer knows the original payment was legit.
I would not be surprised if this was the case or if they paid slightly more when all was said and done. Billers aren’t cheap