Sobertec LLC v. UnitedHealth Group Inc.

I. BACKGROUND

Plaintiffs allege the following. Plaintiffs operate addiction treatment facilities in Orange County, California that are licensed and certified to provide detox, residential inpatient, and intensive outpatient services. (Complaint, Dkt. No. 1-1, Ex. A ¶¶ 53, 54.) UHIC and UHSLLC provide or manage health insurance coverage policies at issue with the other defendants. (Id. ¶ 74.) UBH and Optum are responsible for reviewing, authorizing, processing, and paying claims submitted by Plaintiffs for beneficiaries of UHSI, UHIC, and/or UHSLLC. (Id. ¶ 75.) UBH and Optum are responsible for reviewing and responding to provider appeals and performing so-called audits and investigations of mental health services providers, including Plaintiffs. (Id.) Plaintiffs have been providing addiction treatment services to Defendants’ insureds as out-of-

CUENNTITREADL S DTIASTTERSIC DTI SOTFR CICATL ICFOOURRNTIA

CIVIL MINUTES - GENERAL

Case No. SACV 19-1206 JVS (MRWx) Date September 5, 2019 Title Sobertec LLC v. UnitedHealth Group, Inc., et al.

Although no in-network agreement applied, Defendants’ insureds sought out Plaintiffs as their providers to render…