A federal law called the Mental Health Parity Act forbids most insurance from discriminating against mental health conditions. Under the law, insurers generally must cover mental health conditions to the same degree they cover physical ailments. The judge found UnitedHealth’s internal guidelines developed in response to the Mental Health Parity Act deviated from generally accepted standards of care and made it harder for patients to obtain coverage for mental health treatment. As a result, UnitedHealth’s guidelines made it harder for patients to obtain coverage. Among other things, UnitedHealth emphasized treating crisis symptoms over preventative care. The judge found UnitedHealth’s defense of its guidelines was evasive and deceptive.
Instead of complying with the law, UnitedHealth’s guidelines were found to promote UnitedHealth’s profits. The judge noted UnitedHealth ignored generally accepted criteria for making coverage determinations out of concerns compliance would cost the company money. To ensure that costly treatment would be routinely denied, UnitedHealth gave its fiance department veto power over its coverage guidelines.
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