By Alisa Roth

MPR News/90.1 FM

Max Tillitt’s parents thought they were close to saving him.

Their son had struggled for years with mental health problems and substance use, products of a violent hit during a junior year high school football practice that left him with a concussion and neck injury so bad he couldn’t play anymore.

It changed Max, creating behavioral problems that got him kicked out of school and mixed up with people who opened doors to marijuana, prescription painkillers and heroin. The young man who’d grown up looking out for others in need needed help.

When Max was 21, the Tillitts thought they found an answer, a treatment center where their son finally seemed to be recovering. And they had insurance to cover it — a UnitedHealth plan they thought would pay for Max’s treatment costs until doctors pronounced him well.

UnitedHealth, however, had its own methods to decide how much was enough.

Twenty days into the program, UnitedHealth stopped paying for treatment, according to his parents. Max’s doctors appealed to the insurer, saying Max was nowhere near ready to leave, but he was discharged. His parents found outpatient treatment and he started improving, but a UnitedHealth mistake interrupted his coverage, his mother said. By the time it got resolved, it was too late. Max had lost momentum.

Max didn’t make it to 22, dying of a heroin overdose in 2015 after relapsing and finding his way back to his old dealer.

His story is now part of a class action lawsuit that may include as many as 50,000 people challenging UnitedHealth’s standards for behavioral care. U.S. Chief Magistrate Judge Joseph C. Spero recently ripped the Twin Cities-based insurer for placing an “excessive emphasis” on paying for treatments during a crisis while ignoring “effective treatment of … underlying conditions.”

Spero ruled United Behavioral Health, which manages behavioral health services for UnitedHealth members, violated its financial obligation to clients.

UnitedHealth has declined to comment but told the court it can show that its decision making was consistent with “evidence-based treatment and the terms of the health plans.”

A 2008 federal law requires insurers to treat mental health care the same way they treat physical health care. Insurers, though, can find strategies around it, such as not having enough people in-network to provide mental health care or making it hard to get the medications people need, said Haiden Huskamp, an economist who studies behavioral health at Harvard Medical School.

Huskamp compares UnitedHealth’s behavioral health standard to an insurer covering only an emergency in diabetes, but not long-term management of the disease. They’ll cover the crisis, she said, but “when [the patient comes] home, you’re not going to cover their insulin or their routine care like their diabetic eye exams or the other kinds of care they need to stay healthy.”

DeeDee Tillitt, Max’s mother, believes Max would still be alive if UnitedHealth had OK’d more time in treatment.

“It’s just so maddening,” she said. “This is just such a waste. I mean, you know, he wasn’t diagnosed with terminal cancer. He had a treatable illness.”

‘They just basically said no’

The class action suit includes UnitedHealth customers from 2011 to 2017 who were working through a wide range of disorders when they were denied coverage.

Like the Tillitts, many believed their policies covered medically appropriate treatment not just during a crisis, but ongoing care for the underlying condition.

Chuck Lesniak of Austin, Texas, said his middle-school daughter developed severe anorexia five or six years ago to the point where she was nearly passing out every time she stood up, “just eating very very small amounts and it became very bad, very very quickly.”

An eating disorder specialist in Austin said she either needed inpatient hospital care or care in a residential treatment center right away or she could die. Lesniak was an employee of the city of Austin, which provided employee health coverage through UnitedHealth. The doctor warned them, though, it would be hard to get UnitedHealth to cover it after the crisis passed.

That’s what happened. Lesniak’s daughter was at the treatment center for six or eight weeks when she reached an acceptable weight, at which point UnitedHealth said it was done paying.

On the doctors’ urging, Lesniak said he kept his daughter at the center for about seven more months. The bill topped $200,000. He said he kept trying to get UnitedHealth to pay and even asked the city of Austin to help since the city provided his health insurance. Both refused.

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For the entirity of this story, visit www.mprnews.org/story/2019/04/22/behavioral-health-insurance-unitedhealth-treatment-suit