“Breaking News: U.S. Department of Labor Uncovers Widespread Violations in Mental Health Coverage”
The U.S. Department of Labor has recently uncovered widespread noncompliance and violations of federal law in how health plans and insurers cover mental health care, echoing the findings of a recent investigation by ProPublica. The report, released on Jan. 17 in conjunction with the Treasury and Health and Human Services departments, revealed that health plans and the companies administering them have been excluding crucial behavioral treatments, such as therapies for substance use and autism, and offering inadequate networks of mental health providers.
The 142-page report detailed the results of secret shopper surveys of over 4,300 mental health providers listed in insurance directories, exposing an “alarming proportion” of unresponsive or unreachable providers. These error-ridden plans, known as ghost networks, make it challenging for patients to access the necessary treatment. Since 2021, the Labor Department has addressed violations in health plans serving more than 7 million individuals, working to rectify issues by seeking changes to plan provisions, policies, and procedures, as well as ensuring wrongly denied claims were paid.
Despite some progress made by plans and insurers, the report acknowledged that they continue to fall short in providing adequate mental health coverage. The report focused on the enforcement and implementation of the federal Mental Health Parity and Addiction Equity Act, which mandates equal access to mental health care as medical care. The Labor Department has faced challenges in holding insurance companies accountable for improperly denying mental health coverage due to staffing and budget constraints.
Timothy Hauser, a deputy assistant secretary of labor, highlighted ongoing investigations into the oversight and management of doctors hired by insurance companies who repeatedly deny mental health coverage for patients. The agency is probing how insurers use and supervise these doctors to ensure fair and impartial reviews of coverage decisions. ProPublica’s investigative reporting has raised significant concerns around these issues, prompting the agency to take action.
The report also shed light on how insurance companies rely on doctors to determine the medical necessity of treatment sought by patients, often leading to coverage denials. Hauser emphasized the importance of impartiality in these reviews and the need to prevent any incentives for physicians to favor denying claims. Insurers like UnitedHealth Group, Cigna, and Blue Cross and Blue Shield have stated their commitment to providing quality care and ensuring appropriate coverage decisions through regular audits and mentorship opportunities for doctors.
The story of Emily Dwyer, a teenager denied coverage for severe anorexia by United Healthcare, exemplifies the consequences of insurance companies’ decisions. Despite initially losing the lawsuit, the Dwyers appealed to the 5th U.S. Circuit Court of Appeals, which ruled in their favor, criticizing the denial letters issued by doctors as unsupported by medical evidence. Dwyer expressed hope that the Department of Labor’s investigation will lead to meaningful action and address systemic issues within insurance companies’ operations.
Overall, the report highlights the urgent need for improved oversight and enforcement to ensure individuals receive the mental health care they require without facing unjust denials or barriers to treatment. The Department of Labor’s ongoing investigations and efforts to hold insurers accountable are crucial steps towards achieving parity in mental health coverage and safeguarding patients’ access to essential care.