Washington state will impose a $500,000 fine on UnitedHealthcare for failing to demonstrate its compliance with mental health parity laws.
According to an Oct. 18 news release from Washington Insurance Commissioner Mike Kriedler, the company failed to address higher denial rates for inpatient care for mental health and substance use disorder than for inpatient medical services and disparities in reimbursement rates for mental health providers compared to medical and surgical providers.
Under a compliance plan, UnitedHealthcare must report its prior authorization, office reimbursement rates and out-of-network provider rates for mental health and medical services to the insurance commissioner's office every six months for two years. If the reports show more than a 10 percent disparity between mental healthcare and medical or surgical care, UnitedHealthcare must show the office how it plans to solve the disparity.
UnitedHealthcare will also report its network adequacy standards for mental healthcare and medical care to the insurance commissioner. Half of the $500,000 fine is suspended, pending UnitedHealthcare's adherence to the compliance plan, according to the news release.
"We are committed to ensuring members have access to mental healthcare under their health plans and in compliance with state and federal rules. We had already implemented changes, as insurers received some clarity around NQTL reporting and other processes," a spokesperson for UnitedHealthcare said in a statement shared with Becker's. "We will continue to support members with increased access to providers and new ways to quickly get the effective behavioral support they need."