UnitedHealth must redo 67K claims, judge rules

Despite objections, UnitedHealth Group has to reprocess 67,000 medical claims for behavioral healthcare that it previously denied, a federal judge said Jan. 27.

UnitedHealth was ordered to redo the claims in November 2020. The order came after a March 2019 ruling from Judge Joseph Spero of the U.S. District Court of Northern California. He ruled that a UnitedHealth unit instituted guidelines that denied care to patients needing mental health treatment to cut costs.

In his Jan. 27 order, Mr. Spero overruled two objections UnitedHealth had to the terms of the appointment of a special master to independently monitor and oversee UnitedHealth's compliance with the reprocessing order. Mr. Spero rejected UnitedHealth's objection to the reprocessing order, stating, "The vague references to the plan administrator's discretion that [UnitedHealth] proposes be included in the appointment order do nothing to clarify the Court's conclusions and will more likely cause confusion."

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