Insurance Commissioner Must Enforce Mental Health Parity Law, Says Provider Group

The health insurance industry may be deviating from its regular authorization process for healthcare to routinely but arbitrarily deny mental health services, according to a complaint to the Insurance Division from a group of behavioral health providers.

The Tri-County Behavioral Health Providers Association complained of widespread denials and limitations on services that are not determined by medical efficacy and an opaque, inconsistent process to getting the claims approved.

The providers argue that leading insurers may be grudgingly sticking to outdated conventions and administering mental health insurance claims arbitrarily different than they do physical healthcare claims -- even though that practice was outlawed under the Affordable Care Act and the Oregon Mental Health Parity Law.

“We believe enforcement of federal and state mental health parity statutes remains inadequate,” wrote Drew Henrie-McWilliams, the association president and CEO of Morrison Family & Child Services.

The group is asking Insurance Commissioner Laura Cali to do a market conduct examination to analyze whether and how the state’s health insurers are failing to comply with state and federal law. An examination could recommend a more orderly and transparent process to authorize mental health services so that it parallels the authorization process for traditional healthcare.

Cali’s office did not respond to questions about the complaint by press time.

Morgan O’Toole, the CEO of the Kartini Clinic, a pediatric behavioral health provider and a member of the provider association, said that the restrictions that have been imposed on mental health providers would never fly if placed on physical health providers.

“Mental health parity means that physical health and behavioral health have to be treated the same way by insurers,” O’Toole said. “They’re not allowed to have two different standards.”

O’Toole accused health insurers of being focused on immediate profits over longterm costs to the system and patient health, and were standing in the way of coordinating care.

As an example, he said health reforms that look at the whole patient would manage chronic conditions like diabetes and depression at the same time, but because of the limits being arbitrarily imposed by insurers on depression treatment, patient health could worsen both for diabetes and depression.

Henrie-McWilliams’ letter says insurers have been limiting sessions and treatment timelines based not on an impartial review unique to the patient but on their own record of denial and limitations imposed on other patients.

The letter also states that third-party physician reviewers -- who can deny or approve the claims -- are not given access to real-time patient records and have sometimes been unqualified. O’Toole said that the insurers have asked adult psychiatrists to approve child behavioral health treatment that is outside their scope of practice.

As an example of the insurance industry’s cruel mischief, Henrie-McWilliams cited a California court case from 2014 where United Behavioral Health arbitrarily denied claims for a woman suffering from anorexia, absurdly arguing that she was not a suicide risk so long as she was receiving in-patient treatment, for which they refused to pay. The 9th Circuit Court of Appeals ruled against United.

Correction: Morgan O'Toole's position at the Kartini Clinic is CEO, not manager.