On Tuesday, a federal appeals court overturned landmark decision That requires the nation’s largest behavioral health insurer to adopt stricter standards for mental health and substance abuse treatment and reprocess tens of thousands of claims.

The U.S. Court of Appeals for the Ninth Circuit ruled that United Behavioral Health fully complied with plan terms when it denied self-insured and fully-insured employer health plans for inpatient and outpatient treatment between 2011 and 2017.

A UnitedHealthcare spokesperson wrote in an email: “We are satisfied with the court’s decision and continue to provide our members with the mental health care they need, when they need it, as part of our commitment to the quality care available. part of a wider commitment.”

Individuals on their employer’s health plan can petition the court to reopen the case. Attorneys for the program, Zuckerman Spaeder and Psych-Appeal, did not respond to interview requests.

The case stems from two omnibus class-action lawsuits filed against the UnitedHealthcare division in 2014, alleging the insurer’s unreasonable interpretation of plan rules violated its fiduciary duty to its members under the FEISA. Adult and child plaintiffs claim United Behavioral Health has a conflict of interest because denying claims enables it to profit from a larger portion of member premiums.

But the Ninth Circuit said insurers are not required to cover all treatments that meet accepted standards of care.

“Even if UBH has a conflict of interest because it is the plan administrator and insurer of the all-insurance plan that is its primary source of income, this does not change the outcome of these facts,” the Ninth Circuit wrote.

In November 2020, a lower federal court asked UBH to reform its claims handling so that coverage decisions are based on guidelines outlined by professional medical societies, such as the American Association for Addiction Medicine. Experts said at the time that the decision set a legal precedent for defining how insurers must make patient coverage decisions. U.S. District Judge Joseph C. Spero also ordered UBH to reopen more than 67,000 of the claims in question.

However, Ninth Circuit Judge Danielle J. Forrest wrote in a partial dissent Tuesday that there are many problems with each individual medical condition. Because many class members have already received alternative treatment, they may not benefit from reprocessing claims, she wrote.

“Simply put, reprocessing is not the remedy that plaintiffs seek, but the means by which they seek redress,” she said.

A sort of separate class action Similar claims have been filed by UBH members whose claims were denied between June 2, 2017 and early February 2018. The case is ongoing.