Insurance Commissioner says CA needs more mental health parity compliance

A 60 Minutes story on Dec. 14 featured Anthem BlueCross Blue Shield’s failure to comply with mental health parity law by denying claims for two California women with bipolar disorder and bulimia seeking medically necessary treatment. California Insurance Commissioner Dave Jones not only confirmed the validity of the story, but revealed that instances of Anthem’s noncompliance are part of a larger, ongoing battle with carriers and the California Department of Insurance.

“60 Minutes highlights Anthem Blue Cross’ history of denying coverage for vital mental health treatment despite mental health parity laws, but they are not the only insurer that has denied coverage for lifesaving care to those who suffer from mental illness,” said Jones. “[The story] puts a national spotlight on the all too common practice of denying people with severe mental illness the medical care to which they are entitled.”

Interpretation of the law is an issue. Specifically, BlueCross Blue Shield has contested in court that residential care for those with eating disorders or other behavioral health needs is not considered a “medically necessary treatment,” and therefore may be legally denied.

The department has taken BCBS to court for noncompliance. In Harlick v. Blue Shield (2011) and Rea v. Blue Shield (2014) the department submitted amicus briefs on behalf of the plaintiffs in the Ninth Circuit Court of Appeals. The 2011 case was a victory for the department with the judge ruling that residential care must be covered under parity law. However, the 2014 overturned the ruling, leaving parity once again a matter of interpretation.

Jones’s office reported that parity for policyholders with autism is also a concern for the department, resulting in the release of additional regulations on Mar. 7, 2014.