Commerce order alleges Medica violated mental health parity laws

The Minnesota Department of Commerce recently announced a second enforcement action in two months to require a major health insurer to remove obstacles to accessing mental health care for Minnesotans. Commerce's consent order with Medica Insurance Company requires the company to make systematic improvements to its processes for mental health coverage, sets a two-year window for Commerce to monitor the company's process changes closely and imposes a $300,000 fine.

The consent order resulted from what's known as a market conduct exam. It alleges Medica violated mental health parity laws, which are meant to ensure coverage for mental health care is comparable to coverage for medical or surgical care. In May, Commerce entered a similar order against HealthPartners.

"Commerce's action with Medica underscores our mission to protect the interests of Minnesota consumers and to ensure that all insurers abide by the law," Commissioner Grace Arnold said. "Access to mental health care has never been more important. We are committed to removing barriers Minnesotans face when accessing mental health and substance abuse care."

State and federal parity laws prohibit health insurers from making it more difficult to get mental and behavioral health care than treatment for other health conditions.

The Medica consent order alleges the company violated those laws by paying providers more for medical or surgical procedures than for mental health or substance abuse disorder treatment. Medica also was more stringent in reviewing mental health claims than in reviewing medical or surgical claims, the order alleges. Further, the order alleges that Medica's explanation of benefits statements, required under Minnesota law, were inadequate.

"The Department of Commerce regularly examines the practices of health insurance companies, including compliance with parity laws, and we take seriously any allegations of violations," said Jacqueline Olson, Commerce assistant commissioner for enforcement.

"Today's [July 12] consent order benefits Minnesotans because it compels a large insurer to make major changes. Those changes will expand access to mental health care in our state. We will not permit insurers to jeopardize access to treatment for Minnesotans who need it."