Insurance commissioner to reverse some mental health coverage denials

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Karen Ducey

Insurance Commissioner Mike Kreidler is telling insurance companies to retroactively cover mental health services they may have previously denied to patients.

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Annie Zak

Staff Writer- Puget Sound Business Journal

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Washington Insurance Commissioner Mike Kreidler is taking a recent Supreme Court ruling — which upheld that insurance companies can't use blanket exclusions to deny mental health coverage — to the next level.

Kreidler, in a letter sent to health insurance issuers throughout the state Monday, said his office will be reviewing denied mental health claims dating back to 2006.

This comes on the heels of Regence BlueShield settling two class-action lawsuits regarding coverage for neurodevelopmental disability therapies last week. Regence is the biggest health insurance company in the state. The two other largest insurance companies, Premera Blue Cross and Group Health Cooperative, also recently settled similar cases.

"Issuers will be instructed to change provisions in their proposed plans that do not comply with Washington State's Mental Health Parity Act," Kreidler wrote in the letter, which was posted to the department's website.

The settlement from last week and Kreidler's announcement to review past denials of coverage signal a sea change in how accessible mental health care will be for state residents in the future.

"Telling insurance companies that they can no longer impose categorical exclusions on mental health services will help all Washington insureds," said Eleanor Hamburger, an attorney for the plaintiffs in the Regence lawsuit, in an email. "Kreidler's proposed reprocessing should help them get their back benefits reprocessed and, if otherwise covered under their insurance policy, paid."

The Office of the Insurance Commissioner will review health plans filed for 2015 to make sure mental health services won't be inappropriately excluded. For past claims, health insurance companies must sort through claims dating back to Jan. 1, 2006 for large group plans and back to Jan. 1, 2008 for small and individual plans in which a mental health service was denied and send letters to enrollees to tell them their claims will be re-evaluated.

Annie Zak covers the health care and biotechnology industries.