Premera Blue Cross was fined $550,000 on Aug. 6 by Washington State Insurance Commissioner Patty Kuderer over alleged violations of the federal Mental Health Parity and Addiction Equity Act and the state’s provider directory regulation.
The insurer is also required to update its provider directories to come into compliance by Oct. 31, according to an Aug. 5 news release.
“These violations are a disservice to the people who rely on Premera’s health plans for their well-being,” Ms. Kuderer said in the release. “Our laws are in place to ensure mental health services are just as accessible as medical services and we will keep holding the companies that don’t follow those laws accountable.”
The Office of Insurance Commissioner claims that Premera failed to give adequate documentation detailing how it applies nonquantitative treatment limitations, like network restrictions or prior authorization, to behavioral healthcare compared to medical care. The explanations are required under the law to ensure equality between physical and mental health services.
The OIC also said Premera’s provider directories were out of compliance, citing outdated gender-affirming treatment listings, a lack of telemedicine access clarity, missing accessibility information in printed directories and no clear indication on whether referrals were required for certain providers.
“We welcome regulatory reviews as part of our commitment to transparency,” a spokesperson for Premera said in an Aug. 6 statement shared with Becker’s. “The Washington Office of the Insurance Commissioner identified areas where our provider directory needed to deliver greater clarity for our members.”
Premera outlined multiple steps, including clearer telemedicine access instructions, monthly directory updates to ensure accuracy for providers that offer gender-affirming care, new accessibility indicators in printed directory and a banner that informs members referrals are not required to see providers. The company plans to have all changes implemented by the October deadline.
“We remain committed to providing clear, inclusive and up-to-date information to support our members’ healthcare journey,” the spokesperson said. “Aligning with regulatory standards reflects our broader mission to support the health and well-being of the communities we serve.”
