Five major health insurers in Connecticut have been fined for violating mental health parity laws, potentially limiting coverage to mental health care and raising concern that patients may be priced out of seeking treatment.
The state Mental Health Parity and Addiction Equity Act requires insurers to submit annual data to the Connecticut Insurance Department, which reviews it to ensure that mental health and substance use disorder benefits are treated the same as medical and surgical benefits. In a recent report, the department cited Aetna, Anthem, ConnectiCare, Cigna and UnitedHealthcare for coverage of mental health treatment that fell short of the coverage they provided for physical illnesses.
"This report shows that while progress has been made, continued work is needed to ensure full compliance," Insurance Commissioner Joshua Hershman said. "We will continue to use data and enforcement to ensure that consumers have fair access to the behavioral health care they need."
According to the report, these carriers had "non-comparable and inadequate [mental health and substance use disorder] networks because of more stringent and limiting reimbursement rate structures demonstrated through disparate reimbursement rates, disparate out-of-network utilization rates, disparate new patient acceptance rates and disparate patient wait times."
Gov. Ned Lamont underscored the state's commitment to mental health parity.
"Mental health and substance use disorders are a fundamental part of a person's overall health and wellbeing," he said. "Connecticut remains committed to strong parity laws that ensure these essential benefits are covered fairly and consistently. This report has identified areas where improvements are needed and highlights the importance of continued efforts to strengthen compliance. The findings make it clear there is more work to do, and the Insurance Department will hold carriers accountable through corrective action plans that deliver real, measurable improvements for Connecticut residents.
Key findings in the report include gaps in documentation supporting how coverage decisions are made, differences in access to behavioral health network access and reimbursement approaches that did not meet comparability standards. The report also highlights the need for improved use of outcome data to identify and address differences and ensure compliance.
The Connecticut Association of Health Plans told Connecticut Public Radio that its members were in the process of understanding the department's findings and identifying ways to comply with federal and state requirements.
"While there may be different perspectives on how certain standards are applied in practice, carriers remain committed to working collaboratively with the Department of Insurance to advance mental health parity," Executive Director Susan Halpin said.
Penalties will be determined based on the nature, severity and duration of violations, as well as prior compliance history, and will be finalized through established administrative enforcement processes, the department said in a news release. It may take additional regulatory action as necessary.
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