Reporting Highlights

• An Insurer Sanctioned: Three states found United’s algorithmic system to limit mental health coverage illegal; when they fought it, the insurer agreed to restrict it.
• A Patchwork Problem: The company is policing mental health care with arbitrary thresholds and cost-driven targets, highlighting a key flaw in the U.S. regulatory structure.
• United’s Playbook Revealed: The poorest and most vulnerable patients are now most at risk of losing mental health care coverage as United targets them for cost savings.

Around 2016, government officials began to pry open United’s black box. They found that the nation’s largest health insurance conglomerate had been using algorithms to identify providers it determined were giving too much therapy and patients it believed were receiving too much; then, the company scrutinized their cases and cut off reimbursements.

By the end of 2021, United’s algorithm program had been deemed illegal in three states.

But that has not stopped the company from continuing to police mental health care with arbitrary thresholds and cost-driven targets, ProPublica found, after reviewing what is effectively the company’s internal playbook for limiting and cutting therapy expenses. The insurer’s strategies are still very much alive, putting countless patients at risk of losing mental health care.