Reporting Highlights
- An Insurer Sanctioned: Three states found United’s algorithmic system to limit mental health coverage illegal; when they fought it, the insurer agreed to restrict it.
- A Patchwork Problem: The company is policing mental health care with arbitrary thresholds and cost-driven targets, highlighting a key flaw in the U.S. regulatory structure.
- United’s Playbook Revealed: The poorest and most vulnerable patients are now most at risk of losing mental health care coverage as United targets them for cost savings.
For years, it was a mystery: Seemingly out of the blue, therapists would feel like they’d tripped some invisible wire and become a target of UnitedHealth Group.
A company representative with the Orwellian title “care advocate” would call and grill them about why they’d seen a patient twice a week or weekly for six months.
In case after case, United would refuse to cover care, leaving patients to pay out-of-pocket or go without it. The severity of their issues seemed not to matter.
Around 2016, government officials began to pry open United’s black box. They found that the nation’s largest health insurance conglomerate had been using algorithms to identify providers […]
This story is especially appalling because the Obama administration farmed out veterans’ health to United Health Care, a population known to have extensive mental health needs. The situation continues under the Biden/Harris adminstration. The cynicism of private enterprise in health care provision is unmatched. For United, the care of veterans is an income stream in which any service provided limits their profit.
Great article and very accurate. Many good therapists will not contract with United because of these practices and their low reimbursement rates. My organization has to engage in these appeals on a regular basis. Appeals are time consuming and they are not paid for. The truth is that insurance companies don’t want to pay for mental health services in a country whose policies are making the citizens mentally ill.
The article did touch upon the fact that long ago Congress passed the Mental Health Parity Act. The problem is, that like many laws it’s fine on paper but if it is not enforced by the Federal or State Government it’s worthless. Every month that goes by without enforcement the insurance company gets richer and the patients are deprived of care that they paid for.
Lastly, the article didn’t go into one of the biggest issues regarding mental health care, the fraud panels. I know that investigative reporting has been done on this but it continues to be a pervasive problem throughout the industry. Want to actually use your insurance to get in network care? Well you consult the two inch thick book given to you by your insurance company to find a therapist only to discover that a very high percentage of therapists are no longer in the plan, or they don’t accept new patients. Insurance companies also “close” their panels when they believe that enough “providers” are in network in the geographic area. This further limits care.
State governments do have the power to dictate to the insurance company that they must accept all willing providers into the network. I’ve been waiting for decades to see if this would occur. Never happens. It’s a great scam for the insurance companies who can make it look to a benefits manager that they offer great coverage, when it’s a fraud. I have seen these practices continue for decades, and the Federal and State governments do nothing about it.
I hate to be the bearer of bad news but its about to get worse. With the introduction of AI there will be no humans to debate with. The computers will make the decisions and human can waste their time appealing, while losing valuable time and money in the process. I would be shocked, just shocked if this horrid situation was in any way connected to campaign contributions……..Think outside the box.