Condry et al. v. UnitedHealth Group Inc. et al., No. 17-cv-00183 (N.D. Cal.)

On January 13, 2017, Chimicles Schwartz Kriner & Donaldson-Smith filed a class action lawsuit in the Northern District of California against UnitedHealth Group Inc.; UnitedHealthcare, Inc.; UnitedHealthcare Insurance Company; and, United Healthcare Services, Inc. (collectively referred to as “UnitedHealth” or “Defendants”) for failing to provide, cover, and administer Comprehensive Lactation Benefits to all eligible plan participants and beneficiaries as a no-cost preventive service in accordance with the Affordable Care Act (“ACA”).

Procedural History:

  • Motion to Dismiss: On August 15, 2017, United States District Judge Vince Chhabria denied, in substantial part, UnitedHealth’s Motion to Dismiss.  UnitedHealth argued that it covers Comprehensive Lactation Benefits as required by the ACA, even if the availability of these services are not communicated to plan participants, and irrespective of plan participants’ ability to identify, reach or receive services from any purported in-network providers.  See Order at pg. 3.   Judge Chhabria called these arguments “absurd,” saying that these services must be available “in a meaningful way” for the plan to comply with the ACA.
  • Motions for Summary Judgment: On June 27, 2018, Judge Chhabria denied, in substantial part, UnitedHealth’s Motion for Summary Judgment, finding that the ACA requires that health insurers provide meaningful access to comprehensive lactation support and counseling and “illusory or de minimis access is not sufficient, and a woman does not have access to lactation support if she cannot practically find those services.” See Order at pg. 2.  Judge Chhabria further rejected UnitedHealth’s “parsing of the statute” with regard to preventive versus diagnostic services, finding that the ACA “requires coverage of lactation support regardless of whether a woman is receiving it in response to symptoms.” See Order at pg. 3.

  • Motion for Class Certification: Plaintiffs moved to certify a nationwide class of similarly situated women on February 20, 2019.  On May 23, 2019, Judge Chhabria issued his ruling denying the motion, but gave Plaintiffs the opportunity to refile a class certification motion.  In denying Plaintiffs’ motion, the Judge commented on the extent of UnitedHealth’s deficient compliance with the ACA by stating: “It seems clear that UnitedHealth’s compliance with the Affordable Care Act’s mandate to provide lactation services has been spotty at best. In fact, it almost seems as if the instances of compliance were accidental,” (Order at pg. 6); and “UnitedHealth’s approach to compliance with the Affordable Care Act’s lactation coverage mandate was disinterested and haphazard…” (Order at pg. 4).

  • Renewed Motion for Class Certification: On September 9, 2019, Plaintiffs moved to certify two classes of persons who did not receive the ACA-mandated preventive care coverage for breastfeeding support and counseling services, and, an additional class comprised of persons to whom United provided an incomprehensible reason for the denial of their claims.  Plaintiffs seek both injunctive and declaratory relief, including requiring United to adopt and utilize proper claims procedures and standards for out-of-network lactation services claims, and to evaluate and process plaintiffs’ and class members’ claims for out-of-network lactation services received from August 1, 2012 to present under the revised procedures.

If you believe that you have been denied breastfeeding support and counseling coverage by UnitedHealth that you’re entitled to receive – please complete the form below.

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Attorneys for this case:

Kimberly Donaldson Smith
Stephanie E. Saunders