New Hampshire’s three biggest health insurers are largely in compliance in covering treatment for alcohol and drug addiction, and are committed to making changes when needed, state regulators said Thursday.
The Department of Insurance began reviewing Anthem, Cigna and Harvard Pilgrim in November 2015 amid a growing opioid crisis across the state and concerns raised by providers and patients about access to treatment services. The review, which covered activity from January through September 2015, included the companies’ provider networks, the appeals process available to consumers and procedures for deciding whether a service is medically necessary. Examiners also looked at the companies’ handling of medications used to treat addiction, and whether companies are treating substance abuse treatment claims on par with medical and surgical claims as required under the Affordable Care Act.
Commissioner Roger Sevigny said the biggest problem for all three companies was their websites, which were deemed difficult for consumers to navigate. For example, those using Anthem’s “Find a Doctor” online tool must first chose the type of care they’re seeking – medical, dental or vision – and aren’t given a way to select “behavioral health” – until the next screen. The company said it is considering adding language that clarifies that medical care includes behavioral health and substance use disorder treatment.
The department also had strong concerns about Harvard Pilgrim’s oversight of the outside company it uses for behavioral health services. Harvard Pilgrim noted that the outside company, United Behavioral Health, has received high marks when audited by a national accreditation organization, but the state noted that it is also required to perform its own annual audits. Harvard Pilgrim said it will revise its contract with the outside company to clarify that it will conduct such audits.
Regulators also were concerned that United Behavioral Health requires pre-authorization for all services, which doesn’t fit with the mental health parity requirements, said insurance department attorney Jennifer Patterson.
The department also was frustrated that it could not obtain accurate data that would allow for a comparison between the claims denial rate for addiction treatment and the denial rate for other services.
“We need to be able to understand and compare practices across carriers, and we can’t do that if we don’t have the data,” Patterson said.
While the review also showed a shortage of addiction treatment providers in some parts of the state, but the companies have taken steps since the review began to address that problem.
“I am heartened to see coverage for behavioral health service improving over time in many areas,” Sevigny said.
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