NEW YORK – After an investigation uncovered widespread violations of mental health parity laws, Attorney General Eric T. Schneiderman today announced a settlement with Schenectady-based MVP Health Care, requiring the health insurer to reform its behavioral health claims review process, cover residential treatment and charge the lower primary care co-payment for outpatient visits to most mental health and substance abuse treatment providers. The settlement, the second against a health insurer so far this year enforcing the parity laws, also requires the health insurance plan -- which has more than 500,000 members in the Albany region, Central New York and the Hudson Valley -- to submit previously denied mental health and substance abuse treatment claims for independent review, which could result in more than $6 million being returned to its members.
An investigation by the Attorney General’s Health Care Bureau found that since at least 2011, MVP Health Care, through its behavioral health subcontractor, Value Options, issued 40% more denials of coverage in behavioral health cases than in medical cases. The agreement with MVP is the second reached by the Attorney General’s office so far this year and stems from a broader, ongoing investigation into health insurance companies’ compliance with mental health parity laws.
“Ensuring that New Yorkers have adequate access to mental health and substance abuse treatment should be a priority for our state,” Attorney General Schneiderman said. “Insurers must comply with the law to ensure that individuals with mental health conditions are treated no differently than those with physical ailments – and that they are getting what they pay for from insurers. With this settlement, MVP Health Care commits to greatly improving treatment services available to thousands of New Yorkers.”
New York’s mental health parity law, known as Timothy’s Law, was enacted in New York in 2006, and requires that insurers provide mental health coverage at least equal to coverage provided for other health conditions.
Mental and emotional well-being is essential to overall health. Every year, almost one in four New Yorkers has symptoms of a mental disorder, but less than half of those people receive treatment. And, despite the fact that in any given year, one in ten New Yorkers has a substance use disorder, only 11% of these individuals receive any treatment. Lack of access to treatment for the vulnerable individuals, which can be caused by health plans’ coverage denials, can disrupt work, family, and school life, and lead to more serious illness.
In one case, the investigation found that MVP repeatedly denied coverage for the treatment of a young woman with a very serious history of substance abuse disorder, even though her providers had prescribed inpatient rehabilitation, residential and intensive outpatient treatment. As a result, the woman’s family was forced to spend a great deal of time on a long series of appeals, and paid more than $150,000 out of pocket for her treatment.
In another case, an MVP Health Care member with a long history of addiction to heroin and prescription painkillers requested coverage for inpatient substance abuse rehabilitation treatment. The plan rejected the claim, citing to the wrong criteria.
The OAG’s investigation further revealed that before 2014, MVP Health Care did not cover residential treatment for behavioral health conditions, even though it is a standard, recommended, evidence-based form of treatment. MVP excluded this type of treatment while covering similar treatment -- skilled nursing, for example -- for medical conditions. In one case, MVP Health Care denied coverage of residential treatment for a young woman with a severe case of anorexia nervosa, a potentially life-threatening condition. As a result, her family had to pay thousands of dollars out of pocket so that she could receive necessary treatment in a residential treatment facility.