This case arose from UnitedHealthcare’s denial of continued residential treatment for a minor diagnosed with severe anorexia nervosa, a condition carrying significant medical risk. Treating physicians documented ongoing medical instability, insufficient weight restoration, and a high likelihood of relapse without continued structured inpatient care.
UnitedHealthcare initially approved a higher level of care but later downgraded coverage and denied continued residential treatment. The insurer relied on utilization review opinions that conflicted with treating-provider assessments and discounted longitudinal treatment records documenting relapse risk and medical necessity.
The Fifth Circuit held that UnitedHealthcare failed to meaningfully engage with the medical evidence submitted in support of the claim. The decision reinforced that ERISA insurers may not justify denials by selectively citing favorable facts while ignoring treating-provider warnings about serious health risks.
