Kreidler calls for insurers to review mental health denials back to 2006

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler is directing all health insurers in Washington state to identify any policyholders who had mental health services denied because of a blanket or categorical exclusion since Jan. 1, 2006 and notify them of their right to have their claim re-evaluated.

The Washington State Supreme Court recently ruled that Washington’s Mental Health Parity Act prevents insurers from using blanket exclusions for mental health services that may be medically necessary. Kreidler sent a letter to the insurers today (PDF, 371KB), outlining his expectations for how to implement the court’s decision and what steps he expects them to take on behalf of consumers.

“The court ruled decisively on behalf of Washington consumers, and I intend to see that insurers doing business in our state follow through on this decision,” Kreidler said.  “I expect the insurers to do a thorough review of all policyholders who may have current and past claims that may be impacted by this decision and to start the process immediately.”

As of Jan 1, 2006, Washington’s Mental Health Parity Act applies to all large-employer health plans and all individual and small-employer plans as of Jan. 1, 2008.  Kreidler is requiring insurers to review mental health denials back to these respective effective dates.

Kreidler had already proposed rules that closely mirror the court’s ruling and also lay out specific steps insurers must take to measure and ensure parity for mental health services. A public hearing on the proposed rules is scheduled for 9:30 a.m. Nov. 5 in Tumwater.

In addition to notifying all affected policyholders, Kreidler is requesting the insurers to collect and report back to his office by March 1, 2015 on:

  • The number of notices sent to consumers.
  • The number of consumers who request an appeal or to have their claim re-evaluated.
  • The outcome of each claim that is re-evaluated.

Consumers with potential claims for reconsideration should expect to be contacted by their health insurer by the end of the year.

In the meantime, individuals who believe they may be impacted by the court’s decision or who have questions about their coverage or past mental health claims that were denied should contact the Insurance Commissioner’s office at 1-800-562-6900 or file a complaint.