Fines hold Illinois insurers accountable for equal coverage of mental health and addiction care | The Kennedy Forum

Fines hold Illinois insurers accountable for equal coverage of mental health and addiction care
July 17, 2020

On Wednesday, July 15th, the Illinois Department of Insurance (IDOI) announced fines against five major insurance companies for violating the 2008 Mental Health Parity and Addiction Equity Act (Federal Parity Law), which requires health plans to cover treatment for mental health and substance use disorders no more restrictively than treatment for illnesses of the body, such as diabetes and cancer.

CIGNA Healthcare of IL, United Healthcare, CIGNA Health and Life, Health Care Service Corporation (Blue Cross Blue Shield of Illinois), and Celtic will pay a combined total of over $2 million. Violations among the insurers included failing to use appropriate medical necessity criteria, unnecessarily requiring prior authorization for treatment, imposing step therapy, and failing to perform proper internal parity testing.

Parity enforcement is more critical than ever as Americans grapple with COVID-19 and subsequent economic and social turmoil, which are already contributing to increasing rates of anxiety and depression across the country. Additionally, new data recently released by the Centers for Disease Control and Prevention (CDC) show that drug deaths in America hit record numbers in 2019 and are steadily rising.

“The state of Illinois has once again stepped up to lead by example in righting a wrong that impacts countless families,” said former U.S. Rep. and lead author of the Federal Parity Law, Patrick J. Kennedy. “Access to affordable, in-network care is one of the most critical aspects of recovery from mental health and substance use disorders. Thank you, Governor Pritzker, for recognizing that, and for taking real action to make a difference.”

The Kennedy Forum Illinois, which leads ongoing efforts to improve enforcement of the Federal Parity Law in Illinois—and was critical to the enactment of Illinois’ 2018 state parity law—praised state leaders. “We appreciate the efforts of AG Kwame Raoul and Director Robert Muriel in holding health plans accountable for these egregious violations,” said Executive Director Cheryl Potts. “Every day, we work hard to ensure people have access to the treatment they need and deserve. Illegal and discriminatory acts by insurers must not stand in the way of progress.”

These actions followed a January 2018 letter that IDOI sent to The Kennedy Forum Illinois committing to launch parity examinations.

Parity Resources from The Kennedy Forum
A website that educates consumers and providers about patient rights under the Federal Parity Law and connects them to essential appeals guidance and resources.
A website where consumers can learn to file appeals—after wrongful denials of insurance coverage for mental health and addiction treatment services—and register complaints against their health plans.
A website where policymakers and others can track legislative, regulatory, and legal parity activities in all 50 states and at the federal level to monitor implementation and best practices.