DOI investigation into behavioral health services results in $115K refund for Colorado consumers


The news was released
Colorado Division of Regulatory Agencies

Following an investigation by the Colorado Department of Insurance (DOI) of health insurance companies and compliance with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), more than 800 Coloradans will receive refunds from the companies. Billed for various behavioral health care services. Collective refunds amount to a total of $115,176.60, and insurance companies that do not comply with federal requirements will be fined a total of $510,000.

“This investigation and refund payment is another example of the decision by the DOI team to make sure we are doing everything we can to help consumers,” said Colorado Insurance Commissioner Michael Conway. “We want to make sure Coloradans have access to high-quality, affordable health care when they use their insurance, including mental health and substance use disorder care. This review is a key part of making sure that happens.”

Insurance plans from 2020 have been reviewed

The MHPAA requires that health insurance coverage for mental health and substance use disorders (SUD), commonly referred to as behavioral health, be comparable to what patients receive for medical and surgical services. Under the law, insurance companies cannot have financial requirements for their behavioral health services that are more restrictive than for physical health services, such as co-pays, deductibles and deductibles.

The department, which is part of the Department of Regulatory Agencies (DORA), has reviewed nearly 500 health plans since 2020. The investigation found that six insurance companies did not meet MHPAEA’s financial requirements, meaning they charged too much for copays, copays and co-pays. or deductibles for certain behavioral health services. Refunds for these consumers ranged from a few dollars to nearly $2,000, with a total of more than $115,176.60 returned to consumers. Affected consumers are contacting their insurance companies with refund checks.

The six companies found to be at fault will face fines ranging from $15,000 to $321,000. However, if the companies demonstrate compliance with the MHPAEA in subsequent years, their penalties may be reduced.

Implementation of MHPAEA

Although insurance companies have been required to comply with MHPAEA since 2008, DOI has provided additional capacity and resources to partially enforce it through HB19-1269, the Behavioral Health Care Coverage Modernization Act. DOI has included an assessment of MHPAEA compliance in its annual review of ACA plans and premiums. This allows DOI to catch compliance issues before consumers are overwhelmed.

Questions about your insurance?

If Colorado consumers have questions about insurance — claims, coverage, denials, improper payments, etc. — they should contact the Insurance Consumer Services team: 303-894-7490 / [email protected] / (Click on “File Complaint”).



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