UnitedHealth Group uses an algorithm that has been subject to legal scrutiny to manage behavioral health costs, ProPublica reported Nov. 19.
In 2021, UnitedHealth Group reached a $14.3 million settlement with New York Attorney General Letitia James to resolve allegations it unlawfully denied mental health coverage to members in New York state.
As part of the settlement, UnitedHealth agreed to stop using ALERT, an algorithm that identified potential overuse of therapy, ProPublica reported. The settlement only applied to plans in New York state and plans under federal jurisdiction, including federal employee benefits.
UnitedHealth also reached settlements with California and Massachusetts to scale back the use of the program in their jurisdictions, ProPublica reported.
UnitedHealth has "quietly rebranded" ALERT, ProPublica alleged, flagging members with high use or frequency of mental health therapy sessions. Care managers use a consultation model, calling providers flagged for high use in around 20 state Medicaid programs, according to company documents obtained by ProPublica.
The company uses a more stringent review method, questioning medical necessity, for psychological testing services and applied behavioral analysis in around 20 states.
Mental health providers told ProPublica they felt the reviews were "intended to discourage them from providing necessary care."
A spokesperson for Optum Behavioral Health, which manages behavioral health services for UnitedHealthcare members, told ProPublica its utilization management programs are compliant with mental health parity laws.
"As the need for mental health and substance use services continues to increase, we're focused on growing and diversifying our behavioral health network to advance health equity, expanding virtual services and collaborating with providers to ensure people receive care," the company said. "Utilization management is an important part of making sure patients get access to safe, effective and affordable treatment. Our programs are parity compliant, while ensuring people receive the care they need."
The Mental Health Parity and Addiction Equity Act of 2008 excluded non-federal government health plans from mental health parity standards. In September, the Biden administration finalized requirements to close the loophole, and would require plans to analyze the outcomes of their mental health coverage policies.
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