Washington Enforcement

(10/2023) Washington State Office of the Insurance Commissioner fines UnitedHealthcare (UHIC) $500,000 for not demonstrating compliance with mental health parity laws.

UHIC failed to show how it administers MH and SUD benefits in accordance with state and federal laws despite at least four separate requests made between 2019 and 2021. The requests detailed issues including higher rates of medical necessity denials for inpatient MH/SU disorder cases compared to medical inpatient stays and lower reimbursement rates for certain MH/SUD providers compared to medical and surgical providers. Half the fine ($250,000) will be suspended if the plan adheres to the compliance plan, which requires UHIC to address its issues and report bi-annually to the Office of the Insurance Commissioner (OIC) for two years. If any report reflects a disparity of more than 10% between behavioral health and medical services, UHIC must show the OIC how it will resolve the disparity. The reports must include prior authorization approval rates for inpatient care, office visit reimbursement rates, and out-of-network provider usage. UHIC will also demonstrate that its network adequacy standards for behavioral health services are comparable to those it applies to medical services.