Although the Mental Health Parity and Addiction Act became law in 2008, behavioral health providers have been voicing concerns over enforcement. From improper use of prior authorizations to inadequate documentation, health insurers have been fined for violating parity laws.
Here are three violations to know:
- Washington state regulators fined Regence Blue Shield $550,000 for failing to show its behavioral health coverage complies with mental health parity laws. The state’s insurance commissioner said Regence did not submit required documentation demonstrating that behavioral health benefits are comparable to medical coverage, as mandated by state and federal law.
- The Delaware Department of Insurance fined UnitedHealthcare $450,000 after completing a follow-up examination into mental health parity compliance and related claims. 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.
- Washington State Insurance Commissioner Patty Kuderer fined Premera Blue Cross $550,000 Aug. 6 over alleged violations of the federal Mental Health Parity and Addiction Equity Act and the state’s provider directory regulation. The commissioner claimed 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 commissioner also said Premera’s provider directories were out of compliance.
