Judge Rules United Behavioral Health Medical Necessity Criteria More Restrictive Than Accepted Standards

On March 5, 2019, a federal court ruled that United Behavioral Health (UBH), a division of UnitedHealth Group, used internally developed medical necessity guidelines to deny coverage for behavioral health treatment that were more restrictive than generally accepted standards for mental health and addiction treatment. The court found that the UBH criteria focused on covering short-term or crisis-focused acute care, but did not account for ongoing, long-term services needed for chronic or complex mental health conditions. The ruling affects people with employer-sponsored health plans for which UBH managed behavioral health benefits from 2011 to 2017 and . . .