Ninth Circuit Reversal of Trial Court Order Equals Big Win for Payors
“On March 22, the Ninth Circuit reversed the trial court’s order and underlying decision in Wit et. al. v. United Behavioral Health and Alexander et al. v. United Behavioral Health (Case Numbers 20-17363, 20-17364, 21-15193, and 21-15194). In doing so, the court undid a pair of orders that had required UnitedHealthcare Group, Inc.’s (United) behavioral health unit to reprocess thousands of claims for substance abuse and mental health treatment after finding United’s coverage guidelines were improper — and thus its denials were unreasonable,” reports Top Class Actions in their JDSupra.
“The Ninth Circuit considered, in large part, whether United’s internal guidelines for mental health and substance abuse coverage contravened generally accepted standards of care. It held that United’s interpretation — that the plans did not require consistency with the generally accepted standards of care — was not unreasonable. In so holding, the Ninth Circuit ruled that the lower court was wrong in finding that United abandoned its duties under ERISA.”
