Insurers violating law requiring equal mental health care

Major health insurance carriers in Connecticut continue to violate the state's mental health parity law nearly seven years after its initial passage, adding to ongoing access gaps, according to a new report from the Department of Insurance.

"I think it's shocking and frankly disgusting that all five of the companies in Connecticut violated this law," said Comptroller Sean Scanlon. "I think that that should be an outrage to the people of Connecticut."

Roughly one in five Connecticut adults experiences a mental health issue each year; however, many struggle to access the care they need.

A recent report from Mental Health Connecticut, for example, found that more than 77,000 Connecticut adults didn't see a doctor because of costs in 2024. Residents were also four times more likely to use out-of-network providers for mental health services than for primary care. The disparity in care also extends to people in Connecticut who need substance use disorder treatment.

Historically, insurance coverage for mental health and substance use disorders has been subject to more restrictive requirements than coverage for medical and surgical care.

One way carriers do this is by applying administrative rules or practices that restrict the scope of care, known as nonquantitative treatment limitations. This can include policies like prior authorization requirements, reimbursement methods, criteria for medical necessity and more.

While NQTLs can be useful tools, federal law requires that they be designed and applied to mental health and substance use disorder benefits in a manner comparable to, or at parity with, medical and surgical benefits. The federal mental health parity laws have been in place since 2008, and yet, adherence varies, especially around NQTLs.

Scanlon and other Connecticut lawmakers sought to hold insurance carriers accountable by passing legislation in 2019 requiring annual reports to the state insurance department showing compliance with mental health parity laws, including procedures and corrective actions to address disparities. The carrier may face financial penalties if found non-compliant.

In 2025, bipartisan lawmakers passed a stronger version of the parity law, now requiring noncompliance reports be made public, while also expanding the use of independent reviews. The law also mandating annual compliance certification and increased financial penalties for violations from $15,000 to $625,000.

Scanlon said being able to publicly identify companies that aren't complying with state law and fine them is a "major victory."

"(Mental health) is way too stigmatized still, and I think anything we can do to break down those barriers is really important... while this may seem like one small thing, it unlocks everything else," Scanlon said. "Because if you can afford to see somebody, it might help make the decision easier for you to go to be seen in the first place."

The first report from the Insurance Department came out in mid-April, and, to Scanlon, the findings weren't overly surprising.

Analyzing 2024 data, the state Insurance Department ultimately found that all five carriers - Aetna, Anthem, ConnectiCare, UnitedHealthcare, and Cigna - failed to adequately link coverage disparities to comparable NQTLs. The policies, as a result, may be making it harder for patients to access in-network care, as seen by low rates of new patients, long wait times and more.

There were inconsistent reporting standards across the five carriers, with gaps in documentation. Some reports lacked detailed analysis of NQTL subcomponents and clear plans to address identified disparities.

Officials from the insurance department also add the need to improve how outcome data is used to identify disparities and address reimbursement processes that don't meet compatibility standards.

"Under state and federal parity laws, mental health and substance use disorder benefits must be treated the same as medical and surgical benefits," said Insurance Commissioner Joshua Hershman in a statement. "This report shows that while progress has been made, continued work is needed to ensure full compliance. We will continue to use data and enforcement to ensure that consumers have fair access to the behavioral health care they need."

The Insurance Department fined the five insurance companies, which must also submit corrective action plans to the state. In a statement, department officials said penalties will be set based on compliance history and the severity of the violation, finalized through the administrative enforcement system.

Three out of five of Connecticut's insurance carriers did not respond to requests for comment from CT Insider.

Aetna and Anthem declined to comment, instead referring reporters to the Connecticut Association of Health Plans. In a statement, association officials said they are reviewing the findings and interpretations.

"While there may be different perspectives on how certain standards are applied in practice, carriers remain committed to working collaboratively with the Department of Insurance, policymakers, providers, and patient advocates to advance mental health parity in a way that is practical, sustainable, and centered on the needs of Connecticut patients and families," read the association's statement. "CTAHP members remain focused on understanding the Department's conclusions and identifying constructive paths to compliance with federal and state requirements."

Between public pressure and hefty fines, Scanlon said he hopes insurance carriers will work to comply with the state law, leading to overall broader access to care. It's all about holding the companies accountable, he adds.

"It's completely unacceptable to me that they knew that this law was passed in 2025. They knew that there were consequences for them. They knew that this would be public, and they did nothing to improve this problem," said Scanlon. "And I think that that's an arrogance that is something we can't tolerate, and that's why I'm glad to see them being fined."