Wit v. United Behavioral Health

Wit vs. United Behavioral Health (UBH) is a landmark case, potentially setting a precedent for how care will be covered for Americans seeking treatment for mental health and addiction.

In a robust and comprehensive 100-plus-page decision in 2019, the United States District Court of Northern California found that UBH was wrong to deviate from the widely accepted clinical standards of care for mental health and addiction. For the remedy, the Judge ordered UBH to reprocess upwards of 67,000 coverage claims for 50,000 patients (half of whom were children) in line with these accepted clinical standards of care. However, in March 2022, a three-judge panel of the U.S. Ninth Circuit Court of Appeals reversed the District Court’s order with a seven-page ruling, arguing that it is “not unreasonable” for insurers to determine coverage inconsistently with generally accepted standards of care. In January 2023, the same three-judge panel issued a corrected ruling that replaced the March 2022 ruling. This new ruling held that – even though UBH violated both its fiduciary duty by creating medical necessity criteria that put its self-interest ahead of plan members’ and the laws of four states – more than 50,000 individuals denied mental health or addiction coverage have no right to reprocessing of their claims.

This new ruling in Wit v. United Behavioral Health is deeply harmful to Americans’ rights to mental health and addiction coverage. The latest ruling is contrary to decades of precedent and will profoundly impair plan members’ rights to health coverage under federal law. The ruling will embolden insurers to make decisions out of step with clinical standards. The ripple effects of this case will greatly impact society.

There’s still an opportunity to reverse this ruling and ensure mental health and addiction are treated in alignment with clinical standards. A rehearing from the full Ninth Circuit offers an opportunity to revisit the panel’s flawed ruling. Amidst our national mental health and addiction crises, an en banc review is essential.

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Case Developments

March 2023

15 states plus Washington, D.C., the U.S. Department of Labor, and advocates including The Kennedy Forum submitted amici briefs supporting a rehearing of the case by the Ninth Circuit Court of Appeals.

January 2023

The Court of Appeals for the Ninth Circuit (3-judge panel) released a new ruling in which they affirmed in part, reversed in part, and remanded for further proceedings. The panel determined that even though UBH violated both its fiduciary duty by creating medical necessity criteria that put its self-interest ahead of plan members’ and the laws of four states – more than 50,000 individuals denied mental health or addiction coverage have no right to reprocessing of their claims.

June 2022

Plantiff’s response to UBH’s June 2022 reply brief

United Behavioral Health’s reply brief (UBH’s response to the appeal).

April-May 2022

Appeal to en banc review (full panel of judges review instead of a small panel).

March 2022

The Court of Appeals for the Ninth Circuit (3-judge panel) reversed the District Court’s ruling. In a paragraph-long decision, the three judge panel determined that it’s “not unreasonable” for health insurers’ coverage determinations to be inconsistent with generally accepted standards of mental health and addiction care.

May 2021

Plaintiffs responded to the UBH appeal with their own court filing, contesting UBH’s legal bases on appeal. Additionally, The Kennedy Forum and 25 other advocacy organizations filed an amicus brief —alongside political leaders like California Attorney General Rob Bonta and the U.S. Department of Labor, which filed its own amicus brief—in support of the lower court’s ruling.

March 2021

UBH attorneys appealed the District Court ruling.

November 2020

Judge Spero issued a ruling related to the remedy phase of this case. The ruling in the remedy phase of Wit v. UBH required the company to reprocess 67,000 claims using medical necessity criteria established by mental health and addiction clinical specialty associations.

February 2019

Judge Joseph Spero of the United States District Court for the Northern District of California issued the findings of fact and conclusions of law in Wit v. United Behavioral Health (UBH), a class action brought against the country’s largest behavioral health insurer. The 2019 decision ruled that UBH’s care utilization review guidelines — named the “Level Of Care Guidelines” — were inconsistent with the generally accepted standards of care utilized by the medical community. Rather than following standards that require treating chronic and co-existing treatments together, the court found that UBH followed internally-developed guidelines that limited coverage to solely “acute” episodes or crises.

Key Legal Documents