The Thread · The Courts
The Lawsuits
When a denial happens once, it's a dispute. When it happens by design, it ends up in front of a judge. These are the cases where the courts — not just patients — are weighing in.
The Documented Record
State Investigation · Sept. 28, 2026
Texas Attorney General investigates Blue Cross Blue Shield of Texas
Attorney General Ken Paxton opened an investigation into Blue Cross Blue Shield of Texas, its parent Health Care Service Corporation (HCSC) and related entities over the denial and delay of urgent, medically necessary care and potentially burdensome prior authorization requirements. One reported case: a newborn whose transfer to a facility able to treat them was allegedly held up by administrative denials and utilization review, even though the procedure was allegedly covered.
The tool is a Civil Investigative Demand under the Texas Deceptive Trade Practices Act, focused on what BCBSTX represented about how it approves and denies claims. That is the misrepresentation theory, applied by a state's top law-enforcement officer.
An investigation, not a finding or a lawsuit — no charges have been filed. Read the press release →
Class Action · nH Predict
Estate of Gene B. Lokken et al. v. UnitedHealth Group
UHG's NaviHealth used a prediction algorithm with a reported 90% error rate to deny medically necessary care to Medicare Advantage seniors. Now a class action.
Lawsuit · Medicare Advantage
Ballad Health sues UnitedHealth Group
Alleging Medicare Advantage manipulation and harm to patients.
Ruling · Cancer Denials
A judge calls cancer denials "immoral, barbaric"
The court's own words for the conduct.
Ruling · $91.2M
Envision Healthcare v. UnitedHealthcare
UnitedHealthcare ordered to pay $91.2M for underpaying a physician group below their in-network agreement.
Settlement · $20M+
DOL v. UMR (UnitedHealth subsidiary)
Accused of denying thousands of claims based solely on diagnosis codes rather than medical necessity; agreed to pay $20M+ to settle.
Settlement · $2.1M
United Behavioral Health — DOL & NY AG
Underpaying out-of-network mental health providers, overcharging patients, and excessively denying treatment, in violation of ERISA.
Penalty · $165M
Massachusetts v. UHG-owned insurers
Ordered to pay $165M+ for a deceptive sales scheme that pushed vulnerable consumers into low-value supplemental products.
Investigation · Autism
ProPublica: UHG culling ABA-therapy providers
Restricting the gold-standard therapy for autistic children to limit spending on rising demand.