Washington Commissioner Fines UnitedHealthcare $500K

Washington Insurance Commissioner Mike Kreidler imposed a $500,000 fine against UnitedHealthcare Insurance Company for reportedly failing to demonstrate how it administers its mental health and substance use disorder benefits in accordance with state and federal laws.

Half of the fine was suspended, pending adherence to a compliance plan.

“We expect companies to deliver critical benefits to consumers who need them, without barriers, and to demonstrate their compliance when asked,” Kreidler said. “If they cannot do so, we will hold them accountable.”

UHIC failed to sufficiently demonstrate how the company administers its mental health and substance use disorder benefits, despite at least four separate requests made between 2019 and 2021, according to Kreidler’s office.

Specific issues included:

• Failure to address an apparent disparity that showed a higher number of inpatient facility mental health/substance use disorder cases reviewed and denied for medical necessity, compared to inpatient facility stays associated with a medical service.
• Failure to address an apparent disparity between UHIC’s reimbursement rates for certain types of mental health/substance use disorder providers, as compared to medical and surgical providers.
• Potential non-compliance with state and federal mental health parity laws.

State and federal laws require coverage and access to mental health and substance abuse disorder services to be comparable to — and no more stringent than — medical and surgical services. Federal law also requires insurers to perform comparative analyses showing their plans comply with mental health parity requirements and to provide the resulting documentation to regulators upon request.

Under the compliance plan, UHIC must work with the OIC to address its issues and report to Kreidler’s office every six months for two years. UHIC has also agreed to show that its network adequacy standards for behavioral health services are comparable to those it applies to medical services.

The suspended fine will be imposed if UHIC doesn’t follow the compliance plan. The OIC could take additional enforcement action if it determines that UHIC is violating additional mental health parity laws.

Topics Washington