Insurance Commissioner Responds to Insurer Denials of Mental Health Treatment

Insurance commissioner Dave Jones issued the following statement about a 60 Minutes story about insurer denials of coverage denials:

 60 Minutes featured a story last night about Anthem Blue Cross’ denial of coverage for patients needing mental health treatment. I am very pleased to see that 60 Minutes has brought national attention to our disputes with Anthem Blue Cross over their denial of coverage for mental health treatment. Medically necessary mental health treatment, including residential mental health treatment, is required to be covered under mental health parity laws. 

The California Department of Insurance has taken aggressive action to enforce state mental health parity law. The department has initiated enforcement actions against major health insurers in California, filed legal arguments on behalf of patients denied mental health treatment in state and federal court, issued new regulations and directly assisted policyholders who were denied coverage by their health insurer for mental health care. We have been fighting to protect consumers from this type of discrimination for years, said Jones. 60 Minutes highlights Anthem Blue Cross’ history of denying coverage for vital mental health treatment despite mental health parity laws, but they are not the only insurer that has denied coverage for lifesaving care to those who suffer from mental illness. If a patient is denied medically necessary care, such as residential care for an eating disorder or behavioral health treatment for autism, the Department of Insurance is here to help the policyholder get the coverage they are entitled to under the law. This 60 Minutes feature puts a national spotlight on the all too common practice of denying people with severe mental illness the medical care to which they are entitled, continued Jones.

Jones filed amicus briefs on behalf of the patients in two recent cases where coverage for mental health treatment is at issue. In Harlick vs. Blue Shield, the department submitted an amicus brief to the Ninth Circuit Court of Appeals on behalf of a policyholder who sued to get coverage for treatment for anorexia after her insurer denied her claims. The department then submitted an amicus brief to the California Court of Appeal on behalf of the plaintiff in the Rea vs. Blue Shield case. The plaintiff in Rea was also seeking coverage for medically necessary treatment for anorexia 

Additionally, the Department has required health insurers to make changes to their policies to comply with mental health parity law.

Another example of Commissioner Jones’ efforts to protect consumers with mental illness involved recent regulations he issued to make sure policyholders obtain coverage for medically necessary treatment for autism. 

The mental health parity regulations will help end improper insurer delays and denials of medically necessary treatments for people with autism, said Insurance Commissioner Dave Jones. This regulation provides clear guidance to the industry, stakeholders and consumers on the requirements of the Mental Health Parity Act.

Prior to these new regulations it was not uncommon for health insurers to delay or deny medically necessary treatment for individuals with autism. The regulations further define the circumstances in which insurers must cover behavioral health treatments for autism. 

State and federal mental health parity laws are in place to prevent health insurers from denying coverage for mental health care. State law (Insurance Code 10144.5) requires health insurance policies to cover diagnosis and medically necessary treatment of severe mental illnesses for patients of all ages and of serious emotional disturbances of a child under the same terms and conditions applied to other medical conditions. Bipolar disorder and bulimia, the conditions suffered by the two women featured in the 60 Minutes segment, are among the severe mental illnesses for which treatment must be covered.

Last Updated 10/20/2021

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