UnitedHealthcare Sued After Denial of Addiction Treatment Leads to Teen’s Fatal Overdose

UnitedHealthcare is once again in the hot seat over coverage denials. A family is suing and claiming that the provider denied substance abuse treatment before a teen’s death. UnitedHealthcare told 16-year-old John Doe to recover from his addiction at home, according to his grieving family

A 16-year-old Tennessee boy died of a drug overdose after UnitedHealthcare allegedly denied medically necessary residential substance abuse treatment, according to a federal lawsuit filed by the teen’s legal guardians. The suit accuses the health insurer of gross negligence, recklessness, and intentional misconduct, claiming its refusal to approve inpatient care directly led to the boy’s death on May 30, 2024.

Identified as "John Doe" in the lawsuit, the teenager had a history of addiction and mental health issues. Despite repeated requests from his guardians for inpatient treatment that included psychotherapy, UnitedHealthcare issued a denial letter approximately two months before his death. The letter reportedly stated, “You have not tried all lower levels of care available in your area. You can learn to control your behaviors and stay at home. Your family can support you as you get treatment.” The lawsuit contends that this rationale ignored clear evidence from Doe’s medical history that residential care was critically needed.

The teen’s guardians, named in the lawsuit as Jane Doe 1 and John Doe 2, allege that the denial created a dangerous gap in care. According to their complaint, the insurer’s decision was the “proximate and actual cause” of the boy’s fatal overdose. His sister, Jane Doe 2, is also part of the legal action.

“UnitedHealthcare’s denial of treatment for this boy was absolutely mind-blowing,” said the family's attorney, Malcolm B. Futhey III. “His past treatment clearly indicated he needed residential mental-health care. UnitedHealthcare coldly refused such treatment suggesting that he ‘learn to control [his] behaviors and stay at home.’ He then soon died. All that's left to show for his death so far are UnitedHealthcare's savings. His family intends to change that.”

John Doe was covered under TennCare, Tennessee’s Medicaid program for low-income families, which is administered by UnitedHealthcare. Under TennCare’s managed care structure, the state pays the insurer a fixed monthly fee per enrollee. The lawsuit highlights this arrangement, arguing that UnitedHealthcare profited by denying care—spending less than what it received from the state.

The guardians are seeking at least $10 million in compensatory damages for emotional distress, medical expenses, and loss of companionship, and an additional $20 million in punitive damages. The legal filing frames UnitedHealthcare’s denial as part of a broader pattern of behavior by the insurer, which has faced increased scrutiny over claim denials and alleged use of flawed AI systems to determine coverage.

UnitedHealthcare reported record profits in 2024, while also maintaining one of the highest claim denial rates among major U.S. insurers. Data from the Kaiser Family Foundation indicates the company denies approximately 33% of claims, although it asserts that 90% of claims are paid upon submission.

The case has reignited public outrage over the practices of major health insurers, especially among those with personal experiences of denied claims. Though unrelated to Doe’s case, UnitedHealthcare made headlines last year when its CEO, Brian Thompson, was fatally shot in New York City. The motive behind the killing remains under investigation.

John Doe’s guardians maintain that their pleas for help were ignored, and that the teen’s death could have been prevented had the insurer authorized the recommended level of care. The lawsuit emphasizes that the teenager, who had recently moved to Tennessee and was under the care of relatives, deteriorated mentally and emotionally without access to proper treatment.