After months of investigation, ProPublica has published a lengthy article on the inner working of UnitedHealthcare’s tactics to artificially limit mental health claims. The investigation reveals some of the same tactics we have seen in UnitedHealthcare claims – the desire to limit claims, no matter if the treatment is medically necessary or not. Sadly, all of this is done to prioritize profits over people.
Common UnitedHealthcare Tactics
We have run across the following common denial tactics in other UnitedHealthcare claims:
1. Optum, the UnitedHealthcare subsidiary that manages mental health coverage, is taking the lead in identifying medical providers who give “unwarranted” treatment.
2. UnitedHealthcare used an algorithm program called ALERT that was deemed illegal in three states.
3. After those rulings, it has looked at plans in other states where its practices have not been found illegal. Texas is believed to be one of these states.
4. Optum has continued to use quotas with its medical necessity reviews, setting productivity targets for how many cases its employees scrutinize. According to records from this year, the target was 160 reviews per employee, which the company exceeded with 180 reviews per employee.
The full article is found here.
Raval Trial Law
What Can You Do?
If you’re facing challenges with insurance denials or need assistance navigating complex healthcare coverage issues, contact Raval Trial Law. We are dedicated to advocating for your rights and ensuring you receive the coverage you deserve.
