Blue Cross & Blue Shield to pay $5 million for mental health services after audit

Sept. 19--PROVIDENCE, R.I. -- Blue Cross and Blue Shield of Rhode Island has agreed to pay $5 million to expand mental health services following an audit by the state that found the insurer to be "out of compliance" with various state and federal laws.

"We found a number of patterns and practices that needed improvement," said Marie Ganim, the state commissioner of health insurance. "It never came to the point of fining them. They settled this effort by putting money into a fund at the Rhode Island Foundation in lieu of a penalty."

Ganim said that Blue Cross, during the course of the audit, was "tremendously cooperative and very transparent. When we identified issues, they would try to fix them as soon as possible."

The $5-million fund -- $1 million a year -- will be used for prevention of mental health problems and early intervention.

Ganim said her agency is conducting similar reviews of the state's other health insurers, UnitedHealthcare, Neighborhood Health Plan of Rhode Island and Tufts Health Plan, on how they provide mental health services.

The Office of the State Health Commissioner was specifically looking at whether Blue Cross & Blue Shield provided the same level of mental health services as it does physical health services, called mental health parity.

Ganim said her department found that Blue Cross' requirements for prior authorization of prescription drugs used to treat mental health conditions "led to impeded or delayed care or the potential for impeded or delayed care" for patients.

She also said that Blue Cross reviewed in-patient care more frequently than it did on the physical health side.

The state review also found that there were times when a less costly drug was used to treat certain mental health conditions when the more expensive drug would be the preferred choice, according to Ganim.

"Some prescription drugs are so much more effective than alternatives that the requirement for two or more trials of alternative medications and the resulting delay in providing a potentially more effective treatment is unreasonable," the report by the commissioner's office said.

The state review also said that Blue Cross should not "suggest the use of potentially addictive drug(s) opioids as trial alternative medications."

In a statement released Tuesday, Blue Cross said it disagrees with the way the report "characterizes our conduct during the review period, which was 2014, and we strenuously deny any wrongdoing or violation of law."

"I don't believe any insurer has done more to improve the behavioral health landscape in Rhode Island," Dr. Matthew Collins, a vice president for the insurer, wrote. "Our efforts predated this report and will continue long after."

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