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Unequal treatment for mental health care brings $597K in fines for 2 Delaware insurance companies

Brittany Horn
Delaware News Journal

Two Delaware insurance companies are facing nearly $600,000 in fines after the Delaware Department of Insurance found them offering disparate care when it came to behavioral and mental health coverage.

For years, Delaware advocates and family members of those struggling with mental health and addiction said it was impossible to get insurance companies to fairly offer and cover necessary treatment.

The passage of Senate Bill 230 in 2018 – one of more than 100 recommendations by the state Behavioral Health Consortium – required insurance companies to stop providing unequal treatment by analyzing their practices and holding themselves accountable. Though federal law already existed, the state legislation required companies to analyze their mental and behavioral health coverage in 2019 and submit these reports to the state Department of Insurance for review, in an attempt to stop this unequal treatment from occurring.

Insurance Commissioner Trinidad Navarro greets voters at P.S. duPont Middle School as primary election voters are courted by candidates and campaigners Tuesday.

So far, the exams of Highmark and Aetna – the state’s largest insurers – have been completed, yielding thousands of violations, according to the department, and $597,000 in total fines so far.

"We did expect to see a higher number of violations since this is our first assessment," said state Insurance Commissioner Trinidad Navarro, adding that the investigations of UnitedHealth and Cigna are nearing completion.

"We thought there would be a lot," he added, "but we didn't have a lot of complaints commensurate with the violations we found."

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Navarro's office regularly fields calls from consumers who believe they are receiving discriminatory care when seeking help for mental health and substance use disorder. But, he said, many Delaware residents may not even realize they are receiving unfair coverage in the first place – hence the high number of violations compared to low number of complaints.

Highmark  Blue Cross Blue Shield

Violations discovered during the review of mental health parity included different medication and procedure pre-authorization requirements; insurance companies limiting the scope or duration of benefits; and different pharmacy requirements when filling prescriptions — all found when people were seeking care for mental health or behavioral health, sometimes classified as non-traditional health care. 

Advocates and family members, along with state officials, have long wanted this lack of parity addressed so those struggling can get the immediate care they need, rather than be sidelined by cost or time in an attempt to access care.

The state Behavioral Health Consortium, which focuses on behavioral and mental health issues in Delaware, specifically laid out in its three-year action plan how to address the issue of parity, with input from insurance companies represented on the consortium. 

"“Everyone should be able to access the level of care required for the duration and intensity of their behavioral health needs," said Lt. Governor Bethany Hall-Long, who chairs the consortium, in a statement. "Persons should be able to access treatment based on the acuity and severity of their health condition or recovery needs and should never be denied treatment due to insurance practices driven by cost and quotas.”

Already, Navarro said, insurers have complied with the analysis and have promised to make necessary improvements. The reviews will also continue each year to ensure insurance companies are following the law.

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"It's really critical that people having these difficulties contact us," Navarro said. "Every day, we get these types of calls. I often see them on my personal cell, my email, from folks within my staff."

It's these calls that give the Department of Insurance direction when seeking out obstacles at insurance companies – and that's important now more than ever as the COVID-19 pandemic rages on, plunging many struggling with addiction and mental health issues into isolation. 

Both locally and nationally, overdose numbers and suicides have spiked as officials have tried to curb the spread of COVID-19. Reports of depression and anxiety as a result of the pandemic have skyrocketed, and the need for mental health care has only increased.

In Delaware, 303 people have died from a suspected overdose this year.

Just this past weekend, New Castle County police reported an "unusually high number of incidents in which a person has overdosed," with one person dead as a result. Though cause of death is pending, police said they believe heroin was a factor.

The pandemic did prompt both federal and state officials to loosen and adjust the rules around telemedicine, which allowed those at home to access care – especially those in need of mental health and addiction treatment. Early on, local doctors reported higher attendance rates for appointments and follow-ups.

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Navarro said he hopes to codify the adjustment to telemedicine in this next legislative session to ensure those who struggle to see a primary care doctor – specifically those in Kent and Sussex counties, where physicians are limited – will continue to have easier access to treatment.

Ultimately, the goal is to not only make access to care easier, but ensure that every Delaware resident who needs help can receive it, without hurdles or obstacles slowing them down.

"I use this analogy: Spend money now to save money in the future," Navarro said. "The premise behind early intervention is getting people the treatment they need early on. It's impossible to quantify the savings, but you can measure that with lives that are saved."

Struggling with mental health or addiction?

Call the Delaware Hope Line at 833-9-HOPEDE.

If you're experiencing a medical emergency, call 911.

Additional resources can be found at DrugFree.org/Delaware.

Brittany Horn is an investigative reporter focusing on gun violence, mental health and addiction. Got a story to tell? Contact her at (302) 324-2771 or bhorn@delawareonline.com. Follow her on Twitter at @brittanyhorn.