State alleges HealthPartners illegally denied mental health coverage, says the company is cooperating
Updated: 2:00 p.m.
Minnesota officials hit Bloomington-based insurance and health care company HealthPartners with a consent order for allegedly violating laws related to mental health parity.
State and federal laws prohibit health insurance companies from evaluating mental health diagnoses or treatments more stringently than they do for other forms of care.
“This is one example of our commitment to enforcing mental health parity laws and making sure that Minnesotans can get access to the coverage that they've paid for,” said Commerce Commissioner Grace Arnold. “We want to make sure that people have fewer barriers, and this is a way to do that.”
The decision is based on a market conduct exam performed by the Minnesota Department of Commerce. The order alleges that HealthPartners violated these parity laws “by excluding some coverage for residential mental health treatment before 2018,” according to the release.
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The state also says the company reconsidered claim denials for medical and surgical procedures more frequently than denials related to mental health care, and that the company did not “document its internal coverage reviews or meet required timelines.” The order was signed on May 1.
In a statement, HealthPartners said it shares the state's goal of mental health parity and agrees on the plan that's been set to address the state's concerns.
“We think it's a good start to be able to see this and, and frankly, it kind of validates what people who've been trying to seek care have experienced,” said Sue Abderholden, executive director of NAMI Minnesota.
“We see children boarding in the emergency room because they can't access residential treatment, particularly a level of care called psychiatric residential treatment facilities. We see people waiting for three months or six months to even see a therapist, sometimes longer to see a prescriber, such as a psychiatrist,” she said. “And so when we deny access to care, people don't get better. And that is really the fundamental issue here.”
The consent order comes with a $150,000 fine, as well as one year of monitoring over “HealthPartners’ adherence to its new procedures,” per the release. The state says this consent decree will result in the company “revamping its policies and processes to ensure coverage for mental health care is equivalent to coverage for medical or surgical care.” Arnold said the department could also increase the monitoring period, if they felt it was necessary to do so.
“Mental health, in general, is a really timely and important challenge that we're taking on,” Arnold said. “Commerce's role in that is to make sure that insurance laws are enforced. It's a piece of the puzzle. It's not the whole puzzle, but it's something that we take seriously because we want Minnesotans to be able to access mental health care when it's covered under their insurance policy.”
Arnold also noted a 2021 report from the state Department of Health found that Minnesotans experience an average of 4.3 mentally unhealthy days per week.
“Ideally, we're taking down barriers that are related to coverage that we have control over,” she said.
The state said that HealthPartners cooperated in the exam, and that it considered that in evaluating the fine, as well as “its commitment to certain claims repayments, and its dedication of resources to implement its corrective action plan.”
Abderholden said that it’s important for people experiencing coverage or appeal denials to notify the Department of Commerce.
“In this case, it helps to complain,” she said.