ALBANY – New York’s top insurance regulator is tightening rules that require health insurers to cover mental health and substance use disorders at the same level they cover physical health conditions.
The state department of financial services will propose a new regulation requiring insurers to make consumers harmless when their provider directory incorrectly lists a mental health provider as within the network, DFS Superintendent Linda A. Lacewell announced Tuesday .
Many people have reported that they have struggled to find mental health providers through these often obsolete lists and force consumers to make dozens of inquiries, sometimes to no avail. The lists also make it appear that an insurer has complied with mental health parity laws, when in fact they have not.
“Mental health matters more than ever in the midst of a pandemic and as we continue to fight economic and social injustices,” Lacewell said. “Ensuring that New Yorkers receive full benefits for mental health services and substance use disorders, as well as other medical benefits, is vital to breaking down barriers to accessing treatment.”
DFS will also require insurers to demonstrate that their policies will protect consumers seeking mental health and addiction services from unjustified charges or higher co-insurance than those seeking other medical services. They have to prove it before the consumer acquires the policy, DFS said.
State and federal law requires insurers to provide coverage for mental health and substance use disorders that live up to the coverage they would provide for other medical conditions. However, numerous studies over the years have shown that insurers continue to violate so-called parity laws, in part because of supplier shortages, but also because insurers do not pay providers enough to provide services properly. Courts have also found that insurers set unreasonable criteria for people to opt for mental health and addiction services.
Lacewell announced Tuesday that DFS will begin a review of parity compliance later this year based on reports that insurers will have to file in late July. The department will investigate possible parity violations, including cost-sharing requirements, medical denial rates and service approvals, and the number and type of mental health and addiction providers that are networked, to say.