Lisa Gingerich

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The Wit Case - Why it Matters

Posted by Lisa Gingerich on Nov 18, 2019 4:30:00 PM

Lisa M. Gingerich
Michael Best

The Wit v. United Behavioral Health decision (issued by Judge Joseph Spero of the United States District Court in the Northern District of California on March 6, 2019) will impact how managed care coverage decisions are made.  The case addressed claims by several United Health Group members whom UBH denied coverage for behavioral health care.  The lawsuit was based on UBH’s alleged breach of fiduciary duties to its members, under the Employee Retirement Income Security Act (ERISA), when UBH (i) applied coverage guidelines that are far more restrictive than those that are generally accepted (by CMS, American Society of Addiction Medicine and evidence-based medical guidelines) and (ii) prioritized cost savings over members’ interests. 

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