Report: 16 Nevada insurance carriers illegally give mental health care claims short shrift

A state report shows at least 16 insurance carriers in Nevada likely violated the federal mental health and addiction parity law last year, putting more barriers in place for people seeking mental health care than physical health care in a state that has consistently ranked last for overall mental health.

Since 2008, federal law has required plans to cover mental health and substance use treatment the same way they cover medical care. The Affordable Care Act (ACA) includes mental health and substance abuse disorders as one of 10 essential health benefits plans need to offer.

The second annual report, which was compiled by the Nevada Division of Insurance for the private insurance market it oversees and that — for the first time — names the insurers who are out of compliance, found carriers:

The report is the first part of a yearslong process of assessing and ensuring compliance with mental health parity laws. There are additional steps before any carrier is determined to be violating the law and fined.

State Sen. Fabian Doñate (D-Las Vegas), who chairs the Senate Committee on Health and Wellness, said the report was a "disturbing realization" of how Nevada's insurance market often fails to provide fair access to mental health care. The issues outlined in the report, he said, starve provider networks and force families to pay for more expensive out-of-network care.

"By burying mental health patients under double the paperwork and denying their preauthorization more often than medical patients, insurance companies have created a second-class tier of health care that violates the law," Doñate said in a statement to The Nevada Independent.

The 16 carriers flagged for violations include United Healthcare Insurance Co., Aetna Health Inc., SilverSummit Health Plan, Health Plan of Nevada Inc and Sierra Health and Life Ins Co. Three of the plans, Health Plan of Nevada, Molina Healthcare of Nevada and SilverSummit Health Plan, have managed care contracts with the state, meaning they provide Medicaid coverage.

In a statement to The Nevada Independent, the Nevada Association of Health Plans, which represents 10 companies, affirmed the importance of mental health and substance use disorder and pointed to their work on the issue in the 2025 session. They said they weren't aware of the report findings until The Indy reached out; some carriers say they've set up meetings with state regulators to discuss the report.

"We are carefully reviewing their analysis and welcome the opportunity to work with regulators to better understand any concerns and address them appropriately," the statement said.

Katrina Green, a single mother living in North Las Vegas, has experienced access challenges first hand. For years, Green said she faced frequent rejections and delays in care for mental health treatment, 80 percent of which she estimated came because of insurance.

She said having a trained, neutral third party working to resolve those issues would have helped navigate everything from interpersonal relationships to the death of one of her children.

"Had I been able to receive the help that I needed and or needed for my kids when I needed it, I probably wouldn't hold so much resentment today and my load wouldn't be so heavy," Green said. "I don't even need solutions half the time. I just need to get it out loud and say it so that it's heard."

A starting point for accountability

The report, published on Dec. 31, 2025, was not available on the Division of Insurance's website until after inquiries from The Nevada Independent. Initially, the report did not include the names of insurance violators. The details were uploaded to the division's website Feb. 6, following Indy questions about why insurers' names were not part of the public record. State law enacted in 2025, AB207, ended previous confidentiality protections, allowing carrier names to be disclosed. One insurer report is still not linked.

Assm. Lisa Cole (R-Las Vegas), who brought the legislation that required the disclosure of insurers, said she thought the delay in publishing carrier information likely was a "misunderstanding" given that it's a new law.

Plans will likely go back and make sure that the data and information they gave the division is accurate and that there wasn't an innocent mistake that landed them on the violator list, she noted.

"At the end of the day, it's not about finger-pointing; it's about fixing any potential issues that might be there," Cole said. "So we want to make sure people are getting their health care."

Nevada's Insurance Commissioner Ned Gaines noted that while insurers play a role in the difficulties associated with accessing mental health care, they are not the sole driver. Nevada's long-standing provider shortage and beleaguered behavioral health system makes getting care more difficult, and addressing the report findings alone won't resolve the issue, Gaines wrote in response to questions from The Nevada Independent.

"We believe the key takeaway for consumers is that the report provides empirical confirmation, documenting and validating the access challenges many have already experienced when seeking mental health treatment," Gaines said.

Ideally, Gaines said, medical, mental and substance disorder care will be equal in terms of convenience, appointment availability and wait times. There would also be comparable pricing for services of equal time and intensity and no need to go out of network for services, regardless of discipline or provider type.

David Lloyd, chief policy officer at the mental health organization Inseparable, said the state is missing that mark.

Lloyd pointed to data from the Research Triangle Institute (RTI) International showing Nevada patients in 2021 had to go 20 times more often for acute inpatient behavioral health services than for inpatient physical health services. Denial of more routine mental health care can have life-threatening consequences and lead to higher rates of emergency department visits, hospitalizations and higher physical health care costs as well.

"We shouldn't allow that to happen — for insurance companies essentially padding their bottom line at the expense of families and taxpayers," Lloyd said. "When left untreated, it can really increase overall health care costs in a way that's not sustainable."

Giving mental health care shorter shrift also contributes to provider shortages. Many providers, Lloyd noted, find that reimbursement for mental health services is not covering costs, so they can't afford to contract with an insurer.

Monitoring mental health parity under federal law is challenging because of nonquantitative topics such as prior authorization requirements and network adequacy, said Kaye Pestaina, director of patient and consumer protections at the health policy research group KFF.

Plans, Pestaina points out, will argue that the network they have built is limited because there are relatively few providers, and providers will note low reimbursement rates and higher claim denials. Both are problems, she said, adding there can be differences of opinion on how often individuals should be able to see a therapist or receive treatment.

Nevada is not alone with the discrepancy between coverage for physical and mental health.

Rich Collins, a Washington, D.C.-based attorney who has litigated mental health parity violations, said the problem exists in states across the country and extends to ghost networks of providers who can't actually take patients and a rise in insurers' use of artificial intelligence that drives up claim denials.

Enforcement via regulators can take a long time, Collins noted, and fines can feel like a "slap on the wrist" rather than an economic motivator for insurers.

Some states are trying to make the fines sting. In August, Georgia's insurance commissioner issued nearly $25 million in fines for mental health parity violations as a way to encourage compliance with the law.

Next steps

Though violations were found, state law does not prescribe any initial penalties for insurers who ended up on the list and requires additional investigation through a "market conduct examination." Officials with the division estimated that those parity examinations will likely extend into 2027. Once those findings are in, they said the state can take enforcement actions such as fines, which can max out at $50,000.

Gaines said the examinations are designed to determine the underlying reasons for the issues and to have the division implement "targeted solutions" that prevent parity violations from taking place in the future.

Insurance customers struggling to get mental health care can file a complaint with the division.

"We're doing everything we can as regulators to achieve compliance," Gaines wrote. "Again, the problem is ubiquitous, complex and demands comprehensive solutions, beyond mere regulation."

Though the report covers private insurers under the Division of Insurance, officials with the Nevada Health Authority said Nevada Medicaid has created a similar report on mental health parity in the insurance programs it oversees.

But it's all interconnected, and parity issues in one part of the insurance landscape can harm others. Stacie Weeks, director of the Nevada Health Authority, said families who shop for their own coverage shouldn't have to seek out ways to become eligible for Medicaid to address significant behavioral health conditions.

"It is critical that the provider networks in the state's private health insurance market can also help meet the needs of the non-Medicaid, higher-income populations with respect to behavioral health needs," she said. "Otherwise, we risk the continued shift from private paid care to taxpayer-funded Medicaid for these services."