Frequently Asked Questions

1. Why was a notice issued?

You may have received a notice because your rights may be affected by a class action lawsuit (the “Lawsuit”) pending in federal court in San Francisco, California (the “Court”). The Court has ordered that a notice be sent to you. The purpose of the Notice is to inform you how the Lawsuit may affect your rights and what steps you may take. The Notice is not an expression by the Court of any opinion as to the merits of any of the claims or defenses asserted by either side in this Lawsuit.

The Notice provides a summary of the Lawsuit. It also describes who is included in the Class and Reprocessing Subclass, the effect of participating in the Lawsuit as a Class Member and as a Reprocessing Subclass member (if applicable), and how to request exclusion from the Reprocessing Subclass

2. What is this lawsuit about?

This is a civil lawsuit filed in the United States District Court for the Northern District of California. The Complaint names United Behavioral Health as the Defendant.

The Court has certified a Class in the Lawsuit. The Class consists of individuals whose coverage requests for insurance benefits for residential treatment of a mental illness or substance use disorder were denied by UBH, based upon UBH’s 2017 Guidelines, between June 2, 2017, and February 7, 2018. The Court has also certified a subclass (called the “Reprocessing Subclass”) consisting of certain Class members who paid out of pocket for residential treatment for which UBH denied coverage. The Class and Reprocessing Subclass are described more fully below (see FAQ 3 and FAQ 4).

• Plaintiff’s claims

  Plaintiff asserts claims under ERISA, a federal statute. Plaintiff claims that UBH violated ERISA in two ways: (1) by creating and adopting coverage criteria (its “2017 Guidelines”), for its use in adjudicating claims for insurance benefits for residential treatment of a mental illness or substance use disorder, that were more restrictive than generally accepted standards of care and the terms of the Class members’ insurance plans, which Plaintiff claims breached fiduciary duties UBH owed to the Class members; and (2) by using its 2017 Guidelines to deny the Class members’ claims for benefits for residential treatment for a mental illness or substance use disorder, which Plaintiff claims made the denials arbitrary and capricious.

  Plaintiff is asking the Court (a) to declare that UBH’s 2017 Guidelines are inconsistent with generally accepted standards; (b) to order UBH to adopt new Guidelines that are consistent with generally accepted standards and to use appropriate Guidelines going forward; (c) to order UBH to reprocess the Reprocessing Subclass members’ claims for benefits using the new Guidelines the Plaintiffs have asked for; and (d) to order UBH to pay attorneys’ fees and costs to the Plaintiffs’ lawyers.

• UBH denies liability.

  UBH denies any wrongdoing or liability for the claims alleged. UBH denies that it did anything wrong and denies that it breached any fiduciary obligations to Class members when it developed and adopted its 2017 Guidelines. UBH contends that its 2017 Guidelines were consistent with generally accepted standards of care, were consistent with the terms of each Class member’s health benefit plan, and have not been used for several years, so no new guidelines need to be adopted.

  UBH also denies that it abused its discretion as a benefit plan administrator when it denied Class members’ requests for coverage. UBH asserts that its decisions to deny Class members’ requests for coverage were based on, as appropriate, the terms of each Class member’s health benefit plan, the circumstances of each Class member’s situation, and/or the sound clinical judgment of its reviewing clinicians. UBH maintains that it appropriately denied Class members’ requests for coverage in whole or in part because Class members were not entitled to some or all of the benefits they requested under the terms of their individual health benefit plans.

3. Who is a member of the Class?

In an order dated March 11, 2021, as modified on April 26, 2025, and January 12, 2026, the Court certified a Class defined as follows:

• Any participant or beneficiary in a health benefit plan governed by ERISA whose request for coverage of residential treatment services for a mental illness or substance use disorder was denied by UBH, in whole or in part, on or after June 2, 2017, based upon UBH’s 2017 Level of Care Guidelines (“LOCGs”) or upon a Coverage Determination Guideline that incorporates the 2017 LOCGs, and whose request was not subsequently approved, in full, following an administrative appeal.

  The Class excludes any member of a fully-insured plan governed by both ERISA and the state law of Connecticut, Rhode Island or Texas, whose request for coverage of residential treatment was related to a substance use disorder, except that the Class includes members of plans governed by the state law of Texas who were denied coverage of substance use disorder services sought or provided outside of Texas.

  The Class seeks appropriate equitable remedies, including declaratory and injunctive relief. Only members of the Reprocessing Subclass seek a reprocessing remedy. The Class and Reprocess Subclass do not seek an award of direct payment of monetary relief, including in the form of a surcharge.

You can be a member of the Class and not be a member of the Reprocessing Subclass.

4. Who is a member of the Reprocessing Subclass?

In addition, on April 26, 2025, the Court certified a Reprocessing Subclass defined as follows:

• Any member of the Class who incurred expenses for residential treatment for which benefits were not paid, except that the Reprocessing Subclass shall not include Class members whose written notification of denial, as reflected in UBH’s records, (a) identifies a reason for denying the request for coverage other than the Class member’s failure to satisfy UBH’s 2017 LOCGs or a Coverage Determination Guideline that incorporates the 2017 LOCGs, and/or (b) specifies that the member’s failure to satisfy the applicable Guideline was based, even in part, on a portion of the applicable Guideline that was unchallenged in this action.

  Members of the Reprocessing Subclass seek a reprocessing injunction to remedy UBH’s abuse of discretion in denying their requests for coverage based upon an incorrect standard.

Only Class members who fall within the definition of the Reprocessing Subclass are Reprocessing Subclass members.

5. Who represents the Class?

The Class Representative and Class Counsel represent the Class and all of the Class members, including the members of the Reprocessing Subclass. The Court appointed two law firms as Class Counsel to represent the classes in this case. These firms are Zuckerman Spaeder LLP, 2100 L Street NW, Suite 400, Washington, D.C., 20037 and Psych-Appeal, Inc., 7 West Figueroa Street, Suite 300, Santa Barbara, CA 93101. Further information about this case may be obtained from these firms at www.Zuckerman.com or www.Psych-Appeal.com. You may also contact Class Counsel at (202) 778-1800 or (310) 598-3690.

Class Counsel has agreed to pursue this Lawsuit on a contingent-fee basis. That means Class Counsel’s attorneys’ fees and expenses will be payable only in the event of a judgment or settlement in favor of the Class, if any, and will be subject to approval by the Court. Class members will not have to separately pay Class Counsel any additional amounts.

Any Class member may also enter an appearance through their own counsel at their own expense.

6. What remedies are the Class and Reprocessing Subclass seeking?

Members of the Class are seeking declaratory, injunctive, and other equitable relief, including an order (a) declaring that UBH’s 2017 Guidelines are inconsistent with generally accepted standards; and (b) requiring UBH to adopt new Guidelines that are consistent with generally accepted standards and to use appropriate Guidelines going forward. The Class members are not seeking monetary relief, including in the form of a surcharge.

Members of the Reprocessing Subclass seek an order requiring UBH to reprocess their claims for benefits using the new Guidelines the Class members have asked for. That reprocessing could result in a different coverage decision and additional payment of benefits. There is no guarantee, however, that UBH will approve any Reprocessing Subclass member’s request for coverage or pay additional benefits as the result of reprocessing. The Reprocessing Subclass is not seeking direct payment of monetary relief, including in the form of a surcharge.

7. How can I participate in this class action?

You do not have to do anything to participate in the Lawsuit. If you fall within the definition of the Class set forth above (see FAQ 3), you are automatically a Class member. As a Class member, you will be bound by any judgment or settlement, whether favorable or unfavorable, on the claims asserted by the Class in this Lawsuit. You will be able to participate in any relief awarded to the Class in the case.

If you also fall within the definition of the Reprocessing Subclass (see FAQ 4), you are also automatically a Reprocessing Subclass member, unless you choose to exclude yourself (see FAQ 9). As a Reprocessing Subclass member, you will be bound by any judgment or settlement, whether favorable or unfavorable, on the claims asserted by the Reprocessing Subclass in this Lawsuit. You will be able to participate in any relief awarded to the Reprocessing Subclass in the case.

Except as explained below (see FAQ 9), irrespective of whether the Class wins or loses, you will not be able to bring individual legal claims against UBH challenging UBH’s 2017 Guidelines on the ground that they are inconsistent with generally accepted standards of care or challenging UBH’s denial of your claim for benefits for residential treatment of a mental illness or substance use disorder on the ground that UBH’s use of its 2017 Guidelines rendered its decision arbitrary and capricious, nor will you be able to obtain any relief in connection with such claims other than the relief obtained by the Class and, if applicable, the Reprocessing Subclass. You will also be bound if an unfavorable judgment is rendered in favor of UBH.

8. Can I choose to be excluded from the Class?

No. You may not exclude yourself from, or “opt out” of the Class. This means that, regardless of the outcome of this case, you will not be able to bring an individual legal action against UBH seeking declaratory or injunctive relief based on claims asserted by the Class in this Lawsuit. You will be able to participate in any relief awarded to the Class in the case.

9. Can I choose to be excluded from the Reprocessing Subclass?

Yes. If you are a Reprocessing Subclass member, you may choose to be excluded from, or “opt out” of, the Reprocessing Subclass. If you opt out of the Reprocessing Subclass, you will not share in any relief awarded to the Reprocessing Subclass in this Lawsuit, including any reprocessing injunction or any money the Reprocessing Subclass may obtain as a result of any settlement.

However, you will not be legally bound by any of the Court’s orders on the claims asserted by the Reprocessing Subclass in this Lawsuit. You will keep your right to, at your own expense, bring your own lawsuit to seek reprocessing or an award of benefits due on the ground that UBH’s use of its 2017 Guidelines rendered its denial of your request for benefits arbitrary and capricious. Even if you opt out of the Reprocessing Subclass, you will remain a member of the Class. (See FAQ 8).

10. How do I opt out of the Reprocessing Subclass?

If you wish to remain a Reprocessing Subclass member, you do not need to do anything. If you wish to be excluded from the Reprocessing Subclass, you must submit a request for exclusion by following the instructions in the next paragraph. If you choose to be excluded: (1) you will NOT be entitled to share in any relief awarded to the Reprocessing Subclass in this Lawsuit; (2) you will NOT be bound by any judgment or settlement release entered in this Lawsuit with respect to the Reprocessing Subclass members’ claims in this Lawsuit; and (3) at your own expense, you MAY pursue your own claim for benefits due by filing separate litigation.

To be excluded, you must send a written request for exclusion from membership in the Reprocessing Subclass to: Jones v. United Behavioral Health, P.O. Box 25226, Santa Ana, CA 92799. Your request must be postmarked by April 30, 2026. After that date, you will not have the right to be excluded from Reprocessing Subclass membership.

In order to be valid, your request for exclusion must:

1. set forth the name and address of the person requesting exclusion;

2. state that such person or entity requests exclusion from the classes in this Lawsuit; and

3. be signed and dated by such person or entity. Requests for exclusion must be mailed to the address provided below.

Only request exclusion if you do NOT wish to participate in the Reprocessing Subclass and you do NOT wish to share in any potential relief that might be obtained on behalf of the Reprocessing Subclass in this Lawsuit, including a reprocessing injunction.

Exclusion requests should be sent to:

Jones v. United Behavioral Health
c/o Settlement Administrator
P.O. Box 25226
Santa Ana, CA 92799

No judgment or settlement has occurred at this time. If you do not ask to be excluded from the Reprocessing Subclass now, you will not have the right to seek exclusion later, such as at the time of settlement or judgment. However, in the event of a settlement, as a Reprocessing Subclass member, you will have an opportunity to present an objection to the Court if you disagree with the terms of the settlement as it applies to the Reprocessing Subclass.

11. How and when will the Court decide who is right?

Plaintiffs will need to prove their claims either by motion to the Court or at a trial. Either way, the Court will consider all of the evidence and will reach a decision about whether the Plaintiffs or UBH are right about the claims and defenses in the Lawsuit. There is no guarantee that the Plaintiffs will win, or that they will get any relief for the Class.

If there is a trial, you do not need to attend. Plaintiffs’ Counsel and the Class Representative will present the Plaintiffs’ case, and UBH will present its defenses. You or your own lawyer are free to attend the trial at your own expense.

A trial date has not yet been set. If a trial is scheduled, the parties will post the information here.

12. How can I get more information?

This website and the Notice does not fully describe all of the claims and contentions of the parties. Additional information about the Lawsuit, including copies of the Plaintiffs’ Complaint, UBH’s Answer, and the Court’s orders relating to class certification, are available on the Important Documents page.

The pleadings and other papers filed in this Lawsuit are available for inspection during business hours at the United States District Court, 450 Golden Gate Ave., 16th Floor, San Francisco, CA 94102.

Any questions you have concerning the matters contained on this website and the Notice should be directed to Class Counsel or the Notice Administrator.

Do not call the Court or United Behavioral Health.

13. How do I correct my mailing address?

If the Notice was sent to your correct mailing address, you do not have to do anything to receive further notices concerning this Lawsuit. If the Notice was forwarded by the postal service, or if it was sent to an individual or address that is not correct or current, you should immediately contact the Notice Administrator at:

Jones v. United Behavioral Health
P.O. Box 25226
Santa Ana, CA 92799