Dive Brief:
- HealthNow New York Inc., the Buffalo region's largest insurer and the parent company of BlueCross BlueShield of Western New York, is settling over a wrongful denial case regarding $1.6 million in patient claims, Buffalo Business First reported.
- The state attorney general's office argued HealthNow failed to pay for thousands of appropriate claims for outpatient psychotherapy and for more than 100 claims for nutritional counseling due to eating disorders.
- Under the settlement, HealthNow will pay its members for the claims in question, end a policy that put members' psychotherapy claims under review after they surpassed 20 visits, and pay a $60,000 civil penalty.
Dive Insight:
The issue of mental-health parity, which aims to prevent individuals receiving mental health and substance misuse services from getting less favorable benefits than their medical/surgical counterparts, has reared its head in numerous New York cases, with half a dozen settlements having been announced during the past two years with companies including Excellus Health Plan, Cigna, Emblem and Beacon Health.
The matter appears to persist nationwide as well, with advocates arguing therapy limits have simply been replaced with other methods that have the same effect, and with a 2015 report concluding that less than half of state regulatory agencies were actively enforcing the Mental Health Parity and Addiction Equity Act and that only five had taken any action against insurers for violations.
This latest settlement followed an 18-month investigation sparked by consumer complaints regarding the company’s behavioral-health benefits.
The AG's office faulted HealthNow for its 20-visit threshold that resulted in denial of coverage for 3,100 members, as well as its denial of about 125 sessions of nutritional counseling sought by members with eating disorders. The insurer had told them nutritional counseling was not a covered benefit, though it covered the service for patients with medical conditions including diabetes.
"Parity is the new normal," Dr. Colleen Barry, professor and associate chair for research and practice in the department of health policy and management at the Johns Hopkins Bloomberg School of Public Health, recently told Healthcare Dive. "We've passed the phase where transitional violations are OK and need to get to a point where the requirements of parity are being strictly enforced."
As noted by Buffalo Business First, such restrictions go against both federal mental-health parity laws and New York's Timothy’s Law, which requires group health plans to provide coverage for the diagnosis and treatment of mental, nervous or emotional disorders, or eating disorders, equal to the coverage provided for other health conditions.