Mental Health Insurer Sued for Wrongful Death After Denying Coverage to California Resident

A 23-year-old man was a resident at an addiction treatment facility when he got the news that his insurer would no longer cover his stay. Against the urgings of his doctor and his mother, his health insurance company forced him out onto the street after only three days at the facility. The 23-year-old died of an overdose shortly thereafter. His parents are now suing the health insurance company for denying the coverage that could have saved his life. Did the health insurance company’s refusal to extend the young man’s stay at the addiction treatment contribute to or cause his death? A wrongful death lawsuit filed by the decedent’s family alleges that it did.

The family’s lawsuit has been filed against U.S. Behavioral Health Plan of California (OptumHealth Behavioral Solutions). The family alleges that her son’s death from a fentanyl overdose in 2021 was tied to the health plan’s denial of continued addiction treatment. The foundation of the complaint is whether Optum improperly cut the decedent’s stay at the residential facility short over the recommendations of the doctors who were treating him.

The 23-year-old was recovering from fentanyl addiction when he begged his mother for help after learning that his insurer cut his authorization. Three days into his stay at the recovery clinic, a psychiatrist reviewing his case for OptumHealth decided that the decedent should not remain in treatment despite recommendations from doctors and counselors affiliated with the clinic. Days after he was discharged, the decedent overdosed on fentanyl.

According to the wrongful death lawsuit, OptumHealth denied the decedent’s continued stay for financial reasons. They neglected the opinions of doctors and counselors who were treating him at the time and deemed his stay medically necessary.

In 2020, Gavin Newsome introduced legislation mandating that health plans cover all “medically necessary” treatment. CalMatters reported that families and patients still face steep hurdles when it comes to appealing insurance denials. According to data reviewed by CalMatters, health plans still frequently deny appeals, and there is a lack of transparency in how these denials are reached. Even with an appeal, the decedent’s coverage was not extended.

The family’s wrongful death lawsuit seeks to hold the insurer accountable under state laws regulating medical necessity determinations. Experts believe that insurers and their contracted physicians often lack specific training in evaluating complex addiction and mental health cases. The case is set for arbitration next year. An appellate court upheld the insurance company’s arbitration clause.

Talk to an Oakland, CA Wrongful Death Lawyer Today

Venardi Zurada represents the interests of grieving families who have lost loved ones due to the negligence of another party. If you have lost a spouse or a child to another party’s negligence, our Oakland personal injury attorneys can help you file suit against the at-fault party and hold them accountable for their negligence. We serve the Bay Area from our office locations in Oakland and Walnut Creek.  Call our office today to schedule a consultation, and learn more about how we can help.

Source:

lawcommentary.com/articles/mother-sues-health-plan-over-sons-death-amid-denials-of-addiction-treatment