http://www.timesunion.com/news/article/Insurer-fined-900-000-in-settlement-6115886.php
Albany
A Virginia-based health insurance company with offices in the Capital Region was hit Wednesday with a $900,000 fine and has agreed to change the way it handles mental health claims after reaching a settlement with Attorney General Eric Schneiderman‘s office.
Beacon Health Options, which until recently was known as ValueOptions, administers behavioral health benefits for 2.7 million New Yorkers through insurance providers including MVP and EmblemHealth.
The settlement resolves allegations that the company denied mental health claims at twice the rate it did for medical and surgical claims and that it denied claims for drug and alcohol rehabilitation at four times the rate.
“Insurance claims for mental health care should be treated just the same as insurance claims for physical health care, and my office will continue to ensure full compliance with our state’s mental health parity laws,” Schneiderman said in a statement outlining the agreement.
The settlement reinforces ValueOptions’ obligations to submit previously denied claims to an independent appeals process, which could refund millions of dollars to people with MVP and EmblemHealth insurance.
New York since 2006 has required that insurers provide mental health coverage equal to for other medical conditions.
A similar federal law was enacted in 2008.
Under the agreement, ValueOptions will continue to overhaul its claims review process and cooperate with an ongoing independent appeal process.
The company has agreed to remove visit limits for almost all behavioral health services and pre-authorization requirements for outpatient services.
It also will ensure that its provider networks and online provider directories are accurate.
Additionally, it will drop the requirement that people “fail” outpatient substance abuse rehabilitation efforts before becoming inpatients.
“ValueOptions has an unwavering commitment to provide access to high quality behavioral health care services that help our members live their lives to the fullest potential,” the company said in a prepared statement. “Our goal is to ensure individuals receive effective and coordinated care that offers the best opportunity for long-term recovery.”
News of the settlement was welcomed by those who had struggled to get coverage.
“I spent four years of my life battling ValueOptions and their denials,” said an upstate woman, who fought to get coverage for her daughter’s treatment for oxycontin addiction.
She said the firm got addresses or coding for claims wrong and said the treatments weren’t medically necessary.
The woman, who didn’t want to give her name because of the potential stigma, said she went through $160,000, relying on relatives and tapping retirement accounts to pay for 290 days of inpatient treatment.
The company initially approved just seven days of inpatient care, but the family eventually recouped much of the money when the attorney general got involved.
Consumers with questions or concerns can call the Attorney General’s Health Care Bureau Helpline at 1-800-428-9071.
[email protected] • @RickKarlinTU