ProPublica - Insurers Continue to Rely on Doctors Whose Judgments Have Been Criticized by Courts

by Duaa Eldeib and Maya Miller, with research by Kirsten Berg
Dec. 30, 6 a.m. EST

This article contains descriptions of mental illness, eating disorders and suicide.


When Emily Dwyer was 15 and in need of treatment for anorexia, her parents had to refinance the mortgage on their home to pay for it after United Healthcare denied coverage. Credit: Ilana Panich-Linsman, special to ProPublica

Reporting Highlights
•Company Doctors: Insurance company doctors make crucial recommendations on mental health treatment.
•Court Rulings: Judges have repeatedly criticized some insurance companies, and their doctors, for denying this coverage.
•Business as Usual: Companies continue using the same psychiatrists in spite of the harsh rulings.

In a New Orleans courtroom one afternoon this April, three federal appeals court judges questioned a lawyer for the country’s largest health insurance company.

They wanted to know why United Healthcare had denied coverage for a 15-year-old girl named Emily Dwyer, whose anorexia had taken such a toll on her body that she had arrived at a residential treatment facility wearing her 8-year-old sister’s jeans.

The company’s lawyer explained that United’s denial came after three separate psychiatrists working on behalf of the insurer concluded that Dwyer was no longer engaging in concerning behaviors — not over-exercising and not struggling as much at meals. As a result, United’s doctors agreed that, after five months, she didn’t need the additional treatment at the facility that her own doctors said was essential.

The judges on the 5th U.S. Circuit Court of Appeals didn’t appear to buy it. Judge Andrew Oldham said he didn’t understand how the insurance company’s lawyer could stand by a defense that “seems to be not true.”

“The record is teeming, teeming with concerning behaviors,” a frustrated Oldham said.

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