Last month, the US District Court for the Northern District of California certified a nationwide ERISA class action suit against United Behavioral Health (UBH). The lawsuit alleges that UBH is in violation of ERISA because they systemically deny coverage for mental health treatment. ERISA requires that medical necessity be evaluated according to generally accepted standards of care. The suit alleges that UBH develops and applies medical necessity criteria that are outside the generally accepted standards of care for outpatient, intensive outpatient, and residential treatment for mental illness and substance use disorders. The criteria for mental health care is far more stringent than for medical care as it requires the presence of acute symptoms allowing them to deny coverage for treatment needed for individuals who are experiencing chronic and persistent mental illness.
The certification as a class action is important because it means that individual UBH consumers will not need to file separate lawsuits, which is what UBH argued should happen. While this class action was certified in California, it was certified as a nationwide case. The plaintiffs in the case represent all harmed UBH customers, so if the case is decided in favor of the plaintiffs then all harmed UBH consumers across the country may be entitled to monetary relief from UBH.