Anne A. and Kathleen A. v. United Healthcare Insurance Company, United Behavioral Health, and the Apple Inc. Small Business Health Options Program

CourtDistrict Court, D. Utah
DecidedMarch 24, 2026
Docket2:20-cv-00814
StatusUnknown

This text of Anne A. and Kathleen A. v. United Healthcare Insurance Company, United Behavioral Health, and the Apple Inc. Small Business Health Options Program (Anne A. and Kathleen A. v. United Healthcare Insurance Company, United Behavioral Health, and the Apple Inc. Small Business Health Options Program) is published on Counsel Stack Legal Research, covering District Court, D. Utah primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Anne A. and Kathleen A. v. United Healthcare Insurance Company, United Behavioral Health, and the Apple Inc. Small Business Health Options Program, (D. Utah 2026).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF UTAH

ANNE A. and KATHLEEN A., MEMORANDUM DECISION AND Plaintiffs, ORDER GRANTING DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT v. AND DENYING IN PART AND GRANTING IN PART PLAINTIFFS’ UNITED HEALTHCARE INSURANCE MOTION FOR BENEFITS COMPANY, UNITED BEHAVIORAL HEALTH, and the APPLE INC. SMALL BUSINESS HEALTH OPTIONS Case No. 2:20-cv-00814-JNP PROGRAM, Chief District Judge Jill N. Parrish Defendants.

This action arises under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001, et seq. Plaintiffs seek recovery of benefits under 29 U.S.C. § 1132(a)(1)(B) (the “ERISA Claim”).1 ECF No. 83. In March of 2024, the Court remanded the action to Defendants 0F after finding that Defendants’ claim denials were arbitrary and capricious. ECF No. 80. On remand, Defendants upheld the denial of benefits. Presently before the court are Plaintiffs’ motion to re-open the case and the parties’ cross- motions for summary judgment. ECF Nos. 82, 83, 94. Having considered the parties’ arguments

1 In the pre-remand proceedings, Plaintiff also alleged a violation of the Mental Health Parity and Addiction Equity Act under 29 U.S.C. § 1132(a)(3). The court opted to not address that claim in its March 2024 Order on account of it being premature. Plaintiffs do not again raise the claim. See ECF No. 105 at 2 n.1 (“After going through the post-litigation remand process, Plaintiffs do not ask the Court to revisit their claim that United violated the Mental Health Parity and Addition Equity Act . . . .”). and the record, Plaintiffs’ motion to re-open the case is granted, Plaintiffs’ motion for summary judgment (entitled a “Renewed Motion for Benefits, Attorneys’ Fees, Prejudgment Interest, and Costs”) is denied in part and granted in part, and Defendants’ motion for summary judgment is granted.

FACTUAL AND PROCEDURAL BACKGROUND I. Pre-Remand Factual Background The court recites, in a slightly abridged form, the facts as stated in its March 2024 Order. See Anne A. v. United Healthcare Ins. Co., No. 220CV00814JNPDAO, 2024 WL 1307168 (D. Utah Mar. 26, 2024). Defendants United Healthcare Insurance Company (“United”), United Behavioral Health (“UBH”), and The Apple, Inc. Health and Welfare Benefit Plan, sued herein as the Apple, Inc. Small Business Health Options Program (“the Plan”) (collectively, “Defendants”) denied benefits allegedly due to Plaintiffs under the Plan, which is an ERISA-governed employee group health benefit plan. ECF No. 54-2 at 77. At all relevant times, Anne was a Plan participant, Anne’s daughter Kate was a Plan beneficiary, United was the claims administrator, and UBH was

the Plan’s designated mental health claim administrator. ECF No. 55 at 1–2. Plaintiffs obtained care for Kate’s mental health at BlueFire Wilderness Program (“BlueFire”) and later at Chrysalis, a residential treatment center (“RTC”). ECF No. 56 ¶¶ 24, 31, 41. Plaintiffs sought Plan coverage for Kate’s treatment at Chrysalis between April 18, 2016 and December 18, 2017. Id. ¶¶ 31, 34. Defendants denied coverage. ECF No. 54-3 at 218–19; ECF No. 54-12 at 306–07. Plaintiffs claim Defendants’ wrongful denial of coverage caused them to incur $250,000 in unreimbursed medical expenses. ECF No. 2 ¶ 53. A. The Plan The Plan offers benefits for medically necessary mental health care, including at RTCs. 2 ECF No. 55 at 5. The Plan only covers services that meet the definition of covered health expenses within Defendants’ clinical guidelines for the appropriate level of care. ECF No. 54-1 at 55; ECF No. 54-2 at 165. The Plan gives UBH discretion to make medical necessity determinations and “[t]he fact that a physician or other provider prescribes or orders the service does not, of itself,

make such services Medically Necessary.” ECF No. 70 at 10; ECF No. 54-2 at 64. UBH used its Optum Level of Care Guidelines, which set out criteria for determining RTC coverage, to review Plaintiffs’ benefits claims. ECF No. 54-3 at 215–17. UBH’s Guidelines define RTC services as a “sub-acute facility-based program which delivers 24-hour/7-day assessment and diagnostic services, and active behavioral health treatment to members who do not require the intensity of nursing care, medical monitoring and physician availability offered in Inpatient.” Id. at 215. For RTC care to be medically necessary under the UBH Guidelines, the member must require 24- hour/seven days per week treatment for symptoms that interfere with the safety of the insured or others or that would “undermine engagement in a less intensive level of care without the intensity of services offered in” RTC care. ECF No. 54-3 at 215–16.

B. Kate’s Condition and Treatment Kate’s troubles with depression began in sixth grade, when she attempted to run away, beginning a pattern of self-isolation that led her to stop attending school. ECF No. 54-6 at 399– 400. While Kate denied contemplating self-harm, she made repeated statements that indicated suicidal ideation online and to her parents. Id. at 401 (“Kate made statements to the effect of ‘You would be better without me,’ ‘You are making me want to kill myself,’ ‘No one cares about me,’ ‘No one would miss me if I were gone,’ and ‘I don't care if all my bones break.’”); see also id. at 399. In early 2015, Kate met with Dr. Wesley Dunn, a psychiatrist who specializes in treating 3 children and adolescents. Id. at 403. Their meetings continued for a month, but Kate “said nothing to him” and refused his prescription of an anti-depressant medication. Id. On Dr. Dunn’s recommendation, Kate’s parents took her to an eating disorder specialist, Dr. Carlton. Id. at 404. While her meeting with Dr. Carlton was “terrible[,]” Kate was not diagnosed with an eating

disorder and the family ultimately learned that Kate had not been engaging in self-harm. Id. Near the end of seventh grade, Kate was admitted at BlueFire, an outdoor behavioral health program that offered treatment for children with mental health challenges. Id. at 399. Shortly thereafter, a BlueFire therapist recommended a psychological evaluation, which Dr. Jeremy A. Chiles conducted in May of 2015. See id. at 398–415. Dr. Chiles diagnosed Kate with “Persistent Depressive Disorder, moderate to severe” and “Generalized Anxiety Disorder, moderate.” Id. at 413. Based on the evaluation, Dr. Chiles recommended that Kate be “placed in all all-girls residential treatment center” following her time at BlueFire. Id. Such treatment would “provide Kate with ongoing support, structure, and nurturance to work on and lessen the impact of anxiety and depression, find a direction to pursue in the future, improve relationships with family

members, and develop social skills.” Id. at 413–14. Kate did not obtain RTC care immediately upon leaving BlueFire. Id. at 561. However, her parents “spent weeks calling, applying, and working with United to find a facility that might be available for Kate if needed.” Id. Kate saw different therapists but ultimately decided she would only speak with Dr. Dunn, whom she had been seeing periodically since early 2015. Id. Kate’s situation worsened around her eighth-grade Christmas break. At that time, she “begged [her parent, D.] to send her away to live somewhere else, that her life has no hope, that she is useless, and that no one should care about her.” Id. at 562. When Kate’s parents realized “nothing was helping” her, Kate’s mother Anne took months off work to try to find doctors or 4 RTCs that might be able to help. Id. at 563. On January 19, 2016, Dr.

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Anne A. and Kathleen A. v. United Healthcare Insurance Company, United Behavioral Health, and the Apple Inc. Small Business Health Options Program, Counsel Stack Legal Research, https://law.counselstack.com/opinion/anne-a-and-kathleen-a-v-united-healthcare-insurance-company-united-utd-2026.