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

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2024-12-30 15:30:05

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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.”