The Delaware Department of Insurance has fined UnitedHealthcare Insurance Co. $450,000 after completing a follow-up examination into mental health parity compliance and related claims practices.
The review evaluated a 24-month period of UnitedHealthcare’s operations and identified repeated violations in the carrier’s application of parity laws, including improper use of prior authorization and noncompliant prescription protocols for mental health and substance use treatment, according to a Sept. 17 department news release.
Regulators also cited violations in grievance handling, timely claims processing, arbitration timelines and infertility coverage status. Investigators found UnitedHealthcare applied definitions of specialty drugs and step-therapy protocols inconsistent with Delaware law and failed to incorporate mental health drugs into automated prescription systems, according to the news release.
The insurer was further found to have failed to use the full American Society of Addiction Medicine criteria in determining unlimited medically necessary substance use treatment.
Some violations had been cited in previous examinations, increasing the penalty cost. Including this case, Delaware insurers have been assessed a total of $2.11 million since the state began enforcing mental health parity laws, according to the news release.
