On Tuesday, UnitedHealthcare announced that it has reached an agreement with the California Department of Managed Health Care to stop denying coverage of speech therapy services to its members, the Sacramento Business Journal reports (Robertson, Sacramento Business Journal, 8/27).
Similar Settlement With Kaiser Permanente Foundation Health Plan
In 2012, DMHC reached a similar settlement with Kaiser Permanente Foundation Health Plan.
Since 2009, DMHC had received complaints from more than 100 Kaiser policyholders who were denied coverage for the therapies because they lack a physical or mental health condition, according to agency documents (California Healthline, 2/28/12).
Under the settlement, Kaiser agreed to cover medically necessary physical, occupational and speech therapy services and reimburse members who paid for such services out-of-pocket since January 2009 (California Healthline, 5/31/12).
Details of New Agreement
According to the agreement between DMHC and UnitedHealthcare, the insurer will:
- Provide coverage for medically necessary speech therapy services, as required by state law;
- Reimburse members who paid out-of-pocket for such services in recent years; and
- Revise all current health plan documents to reflect the changes.
The agreement went into effect Friday, and the state did not impose a financial penalty on the insurer.
UHC is required to notify all affected members of the change within 60 days and to notify all of its membership of the agreement in its November newsletter.
Members have until July 30, 2014, to file for reimbursements.
DMHC Director Brent Barnhart said the agreement "ensures UHC enrollees needing speech therapy will receive the care to which they are entitled under the law."
In a statement, UHC said that its original policy "was appropriate" but that the agreement was reached "to resolve this old issue" (Sacramento Business Journal, 8/27).