Colo. Division of Insurance Investigation on Behavioral Health Services Results in $115K Restitution for Colorado Consumers

DENVER, Colorado, June 1 -- The Colorado Department of Regulatory Agencies' Division of Insurance issued the following news release:

As a result of an investigation by the Colorado Division of Insurance (DOI) of health insurance companies and their compliance with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), over 800 Coloradans will receive refund payments from the companies, ]as they were overcharged for various types of behavioral health care services. Collective refund amounts total $115,176.60, and the insurance companies who were found to not be complying with the federal requirements will be fined $510,000 in total.

"This investigation and the refund payments are another example of the determination by the DOI team to ensure we are doing everything we can to help consumers," said Colorado Insurance Commissioner Michael Conway. "We want to make sure Coloradans can get high quality and affordable health care when they use their insurance, including for mental health and substance use disorder care. This review is an integral part of making sure that happens."

Insurance Plans from 2020 Reviewed

MHPAEA requires health insurance coverage for mental health and substance use disorder (SUD), collectively referred to as behavioral health, to be comparable to what patients would receive for coverage of medical and surgical services. Under the law, insurance companies cannot have financial requirements, such as co-pays, coinsurance, and deductibles, for their behavioral health services that are more restrictive than for physical health services.

The Division, part of the Department of Regulatory Agencies (DORA), reviewed nearly 500 health plans from 2020. The investigation revealed that six insurance companies were not in compliance with MHPAEA financial requirements, meaning they charged too much for copays, coinsurance, and/or deductibles for certain behavioral health services. Refund amounts for these consumers range from just a few dollars to nearly $2,000, with a total amount of over $115,176.60 going back to consumers. Impacted consumers will be contacted by their insurance company with refund checks.

The six companies found out of compliance will be financially penalized, with fines ranging from $15,000 to $321,000. However, if the companies demonstrate compliance with MHPAEA in future years, their penalties may be reduced.

Enforcement of MHPAEA

While insurance companies have been required to comply with the MHPAEA since 2008, the DOI dedicated additional capacity and resources to enforcement in part because of HB19-1269, the Behavioral Health Care Coverage Modernization Act. The DOI has incorporated the MHPAEA compliance review into its prospective annual review of ACA plans and premiums. This allows the DOI to catch compliance issues before consumers are overcharged.

Questions About Your Insurance?

Colorado consumers who have questions about their insurance - claims, coverage, denials, inappropriate charges, etc. - should contact the Division of Insurance Consumer Services Team: 303-894-7490 / [email protected] / doi.colorado.gov (click on "File a Complaint").

* * *

Original text here: https://doi.colorado.gov/news-releases-consumer-advisories/consumer-advisory-division-of-insurance-investigation-on