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Washington state insurance regulators say Regence BlueShield provided too little information when they asked it to compare its coverage for mental health care and addiction treatment with its coverage for other forms of care.
Patty Kuderer, the state's insurance commissioner, imposed a $550,000 fine on the carrier last week in connection with allegations that the company failed to provide adequate coverage documentation, according to a consent order signed by Kuderer and Will Genschow, a Regence attorney.
Washington state regulators asked Regence for information about how it adds behavioral health providers to its network and whether it has enough behavioral health providers.
"The data Regence provided, or in some cases failed to provide, demonstrates a lack of accountability for following this nation's insurance laws," Kuderer said in a statement about the fine. "Throughout this process, Regence's staff appeared to willfully misinterpret our questions, dismiss our concerns and generally disregard their own responsibilities to their members' wellbeing."
In the consent order, Regence agreed that the allegations described in the order "constitute admissible evidence that may be considered in any future action by the insurance commissioner involving the company."
But the allegations in the order do not "determine any factual or legal issue" and are not intended to affect any lawsuit by any party other than the insurance commissioner, according to the order.
Regence said in a statement that everyone should have access to high-quality behavioral health care.
"We value our collaborative relationship with the Office of the Insurance Commissioner and worked diligently to provide comprehensive responses to the OIC's inquiries," the company said." We implemented state and federal requirements for behavioral health access in good faith, made necessary updates and will continue prioritizing compliance while supporting future rulemaking for clear, consistent standards."
Regence noted that it added 5,488 new behavioral health providers to its network in Washington state in 2024, added virtual behavioral health provider options, and updated its provider directory system in an effort to make in-network behavioral health providers easier for patients to find.
The Mental Health Parity and Addiction Equity Act: The federal Mental Health Parity and Addiction Equity Act requires employer health plans that cover behavioral health care to provide behavioral health benefits that are comparable to their other health benefits.
Federal regulators have been struggling to apply rules that require a health plan's "non-quantitative treatment limits," such as provider network adequacy, to be comparable for behavioral health care and other forms of care, but Washington state is trying to enforce the "NQTL" rules at the state level.
Patients, employers and state regulators in many states have found that access to behavioral care is often much more limited than access to care for heart attacks or diabetes.
Plan administrators have argued that they face obstacles due to high demand for behavioral health care and a shortage of providers.
The providers maintain that health plans often create their own artificial shortages of behavioral health care providers by refusing to pay the providers adequate rates.
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