State insurance department finds Highmark made it harder to access mental health treatment

Highmark Blue Cross Blue Shield of Delaware must pay the state $329,000 for violating the Mental Health Parity and Addiction Equity Act, the Delaware Department of Insurance announced Tuesday.

Mental health parity laws require insurance providers to cover mental health and substance abuse-related care to the same degree as physical healthcare. A lack of parity can make it more expensive, time-intensive and difficult to access mental health treatment, according to the Department of Insurance, and often discourages people from getting the care they need.

“Ensuring that mental health and substance use disorder benefits are provided on par with physical health benefits is a critical priority, and continued compliance monitoring will help to protect consumers and promote equity in health care access," Insurance Commissioner Trinidad Navarro said.

Delaware law requires insurers to report an analysis of benefits any year in which medical management protocols change. The most recent analysis reviewed Highmark's complaint and grievance handling, policyholder services, utilization review, claims and pharmacy review in the past 15 months.

And while Navarro said Highmark showed "notable improvement" in parity compared to prior evaluations, the insurer still exhibited "a number of violations."

In some cases, Highmark showed more restrictive policy criteria on mental health and substance abuse-related medications, such as the opioid addiction treatment medication buprenorphine. In another case, the Department of Insurance found Highmark denied a member a medically necessary intensive outpatient program for drug and alcohol dependency.

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Other areas of noncompliance found in the examination include noncompliance with complaint records, failure to promptly acknowledge and respond to appeals, length of response to pre-authorization requests and noncompliance with a state law that caps consumer cost-sharing for insulin, according to the Department of Insurance. A corrective action plan is now in place.

Highmark did not reply to requests for comment.

The Department of Insurance said exams are in process or scheduled for additional health carriers.

Send story tips or ideas to Hannah Edelman at hedelman@delawareonline.com. For more reporting, follow them on X at @h_edelman .

This article originally appeared on Delaware News Journal: State insurance department finds Highmark made it harder to access mental health treatment