State vows scrutiny for insurers on mental health coverage

Seven health insurance companies have agreed in recent years to pay the state and consumers $5.6 million for failing to cover mental health care and other services that state law requires.

Last month, U.S. Fire Insurance Company agreed to pay $625,000, and Transamerica in March said it would pay more than $1.3 million after the state alleged the companies failed to cover maternity care, pap tests, mammography, preventive care for children, along with mental health services.

The latest settlements prompted Attorney General Martha Coakley last week to send a letter to the trade group America’s Health Insurance Plans warning that her office would continue to pursue the issue and urging the group to educate its members on the requirements for mental health coverage in state law.

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She specifically noted concerns about plans marketed to veterans who may have urgent health needs.

“Failure to provide coverage of important mandated mental health benefits has a severe and detrimental impact on individuals who need those services, their families, and even their communities,” Coakley wrote in the letter dated May 2.

The letter comes as state governments and courts are looking more closely at whether insurers are complying with laws meant to ensure people with mental illness get the care they need.

A Vermont woman is suing Fletcher Allen Health Care , alleging that the hospital system’s insurance plan for employees violated a 2008 federal law requiring parity in coverage for physical and mental health care.

In Connecticut, state psychiatry associations have alleged that Anthem Health Plans changed billing codes to lower payments to doctors treating patients for mental health needs. The New York State Psychiatric Association earlier this year filed a lawsuit against UnitedHealth Group.

Dr. Don Condie, past president of the Massachusetts Psychiatric Society, said the elementary school shooting in Newtown, Conn., in December pushed state and federal regulators to scrutinize insurers who may be violating the laws regarding care for the mentally ill.

“Anytime something terrible happens involving mental health, people take a little more notice, which is a shame” because the needs exist independent of such tragedies, he said.

But Condie said he has been encouraged by the recent actions.

“I think it’s going to take a lot of little victories” to improve access to mental health care, he said.

A spokesman for America’s Health Insurance Plans said the organization is reviewing the attorney general’s letter. Robert Zirkelbach said, while his organization educates members about changes in state or federal policy, it does not advise them on how to comply with those polices.

“We don’t direct our members on legal or compliance efforts or other aspects of their business operations,” he said.