Two anonymous Madison County residents claim United Healthcare refused to pay for their daughter's treatment at a mental health care facility despite an agreement that promised coverage for such services.
The three residents, identified only as Jane Does 1 and 2 and John Doe filed a complaint Nov. 17 in Madison County Circuit Court against United Healthcare of the Midwest, United Healthcare of Illinois and United Behavioral Health.
The plaintiffs claim they purchased health insurance from United to cover themselves and their unmarried daughter, who was under the age of 19 at the time.
"As part of this Agreement, Defendants agreed to provide coverage for mental health care," the suit states. "Around 2008, Plaintiff Jane Doe 2 was diagnosed with mental illness for which inpatient mental health care was recommended by her health care providers."
Based on United's policy guidelines, in order to receive the inpatient mental health benefits, Jane Doe 2 had to meet at least one of five criteria and six other separate criteria that are not specified, according to the complaint.
Jane Doe 2 met all the criteria, but United denied the coverage for inpatient services, the plaintiffs claim.
"As a result of Defendants' refusals, Plaintiffs were forced to pay for Plaintiff Jane Doe-2's medical care and treatment out-of-pocket," the complaint says.
In the two-count suit, the plaintiffs are seeking a judgment of more than $100,000, plus interest, attorneys' fees and other relief the court deems just.
Tammy M. Julian of Farrell, Hamilton and Julian in Godfrey and Zachary R. Pancoast and Jennifer A. Betz of Moser and Marsalek of St. Louis will be representing them.
Madison County Circuit Court case number: 09-L-1237.