Pritzker Targeting Mental Health Parity Violations Applauded

(Springfield, IL) – A top Illinois behavioral health advocate group is praising Gov. JB Pritzker’s Administration for imposing fines on insurance companies that violated the state’s mental health and addiction parity law.

“We applaud Gov. JB Pritzker and the Illinois Department of Insurance for holding health insurance providers accountable who violate Illinois’ mental health and addiction parity law,” said Illinois Association for Behavioral Health CEO Jud DeLoss. “Illinois residents working to recover from mental health and addiction disorders are entitled to first class, not second class, treatment under the law from health insurance providers, and they will pay price for violating it under this governor.”

The Illinois Department of Insurance (IDOI) announced on Wednesday, July 15, fines totaling over $2 million for five major health insurance companies found to be in violation of the Mental Health Parity and Addiction Equity Act (MHPAEA).

Market conduct examinations performed by IDOI from 2015-2017 show that CIGNA, UnitedHealthcare, HCSC (parent company of Blue Cross Blue Shield) and Celtic had violations that resulted in the following fines:

• CIGNA Healthcare of IL paid the highest fine of $582,000 for failing to use medical necessity guidelines required by statute and the American Society of Addiction Medicine (ASAM), and not allowing providers to request an exception to the company’s step therapy requirement for prescriptions.
• UnitedHealthcare paid $550,000 for four violations, including failing to use ASAM guidelines, requiring prior authorization from the company before a provider can prescribe the patient Buprenorphine to help fight substance use disorder, and requiring prior authorization for prescribing certain ADHD medications.
• CIGNA Health and Life paid $418,000 for violating ASAM guidelines and imposing step therapy for drugs used to treat depression.
• HCSC paid $325,000 for requiring prior authorization from the company before a provider could prescribe the patient Buprenorphine to help fight substance use disorder.
• Celtic paid $208,000 for failing to perform proper internal testing to confirm that all plans are in parity.

Fines will be deposited Into the Parity Advancement Fund to be used for education and advocacy in behalf of behavioral health parity.

davidormsby@davidormsby.com