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Fail-first at the crux of latest parity settlement

March 18, 2015
by Julie Miller, Editor in Chief
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A parity settlement was reached between Excellus Health Plan and New York Attorney General Eric T. Schneiderman this week. It requires the health insurer to cover residential treatment for behavioral health conditions and reform its procedures for evaluating treatment claims.

Excellus must also provide notice of a new appeal right to 3,300 members whose requests for inpatient substance use disorder rehabilitation and eating disorder residential treatment Excellus denied from 2011 through 2014. The estimated value of Excellus’s denial of these individuals’ requests is up to $9 million, according to Schneiderman’s office.

An investigation found that Excellus denied inpatient substance use disorder rehabilitation recovery services seven times as often as inpatient medical services. Many of Excellus’s inpatient substance use disorder rehabilitation denials were the result of its requirement that members fail outpatient treatment multiple times before accessing such care.

“My office has taken an aggressive approach to enforcing mental health parity laws that I hope can serve as a national model,” said Attorney General Scheiderman in a statement. “Mental health and addiction recovery treatments must be regarded the same as other health insurance claims under the law. We will continue to take on those who ignore the law and reinforce the false and painful stigma often associated with these ailments.”

It’s New York’s fifth action enforcing the mental health parity laws since last year. Insurers Cigna, MVP Health Care, and EmblemHealth have already entered into settlements, and more recently, the Attorney General entered into a settlement with ValueOptions, the behavioral health vendor for MVP and Emblem.

In addition to the federal Mental Health Parity and Addiction Equity Act of 2008, New York has a mental health parity law, known as Timothy’s Law, that was enacted in 2006.

Excellus, which is part of the Blue Cross Blue Shield Association, has 1.5 million members and is upstate New York’s largest health plan.

 “The Legal Action Center applauds Attorney General Schneiderman for standing up for New Yorkers in need of substance use and mental health treatment," said Paul N. Samuels, Director and President of the Legal Action Center, in a statement. "For too long, individuals with these disorders have faced barriers to treatment due to discriminatory practices by many health insurers. AG Schneiderman continues to lead the country in enforcing the groundbreaking federal parity law that prohibits such discrimination and helps people access health care. As New York and the country face a growing opioid addiction epidemic, and access to treatment is often a matter of life or death, enforcement of the parity law could not come at a more critical moment.”

A copy of the settlement can be read here.

 

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