Health insurance companies fined $2M for violations

CHICAGO (WIFR) - Five major health insurance agencies were fined a total of $2 million.

The Illinois Department of Insurance said they violated the Mental Health Parity and Addiction Equity Act.

The act makes it so health insurance companies have to cover mental health and substance use disorders just like they would medical or surgical care.

“These fines are a reminder to health insurance companies that my administration is committed to providing the best standard of care for Illinoisans and will protect their right to equitable treatment from health insurance providers,” Gov. Pritzker said. “Seeking treatment for mental health or a substance use disorder is a brave step that should not be met by unnecessary roadblocks and hurdles. We will continue to lead by example and help move the country forward in achieving mental health and substance use disorder parity.”

The following companies were fined for their violations:

CIGNA Healthcare of Illinouis
UnitedHealthcare
CIGNA Health and Life
HCSC, the parent company of Blue Cross Blue Shield
Celtic

IDOI looked at coverage from 2015-2017.

The following fines were handed out:

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.