UnitedHealth's Mental Health Policy Exposé

Overview

• News Source: ProPublica and Democracy Now!
• Main Issue: UnitedHealth's cost-cutting measures affecting autism treatment for children.
• Key Reporter: Annie Waldman from ProPublica.

Investigation Findings

• Focus: UnitedHealth Group and its subsidiaries, United Health Care and Optum.
• Documents: Leaked internal documents reveal strategies to limit mental health care, specifically for autism.
• Methodology: Interviews with hundreds of providers and patients across the country.

Strategies Employed by UnitedHealth

• Therapy Limitation
  • Specialized therapy for autism termed as "gold standard" by the company.
  • Increasing autism diagnoses pressure company's financials.
  • Two-pronged approach:
    • Network Restriction:
      • Preventing new providers from joining networks.
      • Terminating existing provider contracts, citing "cost outliers."
    • Utilization Management:
      • Rigorous reviews questioning the medical necessity of treatments.
      • Resulting in denials of coverage.

Case Study: Sherelle Menard and Her Son

• Profile: Sherelle Menard's son, Benji, diagnosed with autism at age 3.
• Location: Lafayette, Louisiana.
• Situation:
  • Required increased therapy hours due to behavioral challenges.
  • UnitedHealthcare denied additional hours citing lack of progress.
  • Experts affirm therapy's role in maintaining progress.
  • Legal action: Menard pursuing an administrative law review to overturn denial.

Legal Concerns

• Federal Law: Mental Health Parity Act (2008).
  • Insurers should provide equal access to mental and physical health care.
  • Strategies possibly violate Medicaid laws mandating prompt medically necessary care.
• Medicaid Plans:
  • Managed by UnitedHealth in 24 states covering 6 million people.
  • Fixed payment model could incentivize denial of care.

Algorithmic System: ALERT

• Function: Initially for identifying suicide or substance abuse risks.
• Current Use: Identifies therapy overuse.
• Legal Issues:
  • Flagging and questioning providers leading to potential service cuts.
  • Investigated in three states; deemed illegal but adapted for other jurisdictions.
  • Continues operation unless states enforce new regulations.

Conclusion

• Call to Action: Democracy Now! encourages viewer support for their investigative journalism.