This story was originally published on MyNorthwest.com
Premera Blue Cross Washington is facing a fine exceeding $500,000 from the Washington Office of the Insurance Commissioner. The fine is a response to violations of the Mental Health Parity and Addiction Equity Act and Washington’s provider directory regulation.
The company didn’t follow mental health coverage rules, according to Insurance Commissioner Patty Kuderer, as mental health care must be treated the same as physical health care in the state of Washington. Investigators found that Premera was unable to demonstrate a balance in its coverage, failing to provide documents that compared mental health limits to physical health limits.
“These violations are a disservice to the people who rely on Premera’s health plans for their well-being,” Kuderer said. “Our laws are in place to ensure mental health services are just as accessible as medical services, and we will keep holding the companies that don’t follow those laws accountable.”
A balance in coverage means that if a hospital offers unlimited visits to a doctor for a chronic physical condition under a certain plan, it must also provide unlimited coverage for visits to treat chronic mental health conditions.
Premera also did not update its provider directory on gender-affirming care monthly, according to The Seattle Times. Premera’s online provider directory on gender-affirming treatment was listed as “accurate as of December 7, 2021.”
Premera Blue Cross responds to fine
In a statement to KIRO Newsradio,PremeraBlue Cross Spokesperson Courtney Wallace said the health insurer is updating its directory to make clear which providers offer gender-affirming care, how patients can access telehealth services when available, and whether or not their health plans require referrals for certain services.
“We remain committed to providing clear, inclusive, and up-to-date information to support our members’ health care journey,” Wallace said.
She said Premera expects to have the updates finalized by October. The company does not plan to appeal the state fine.
The money from Premera’s fine will go toward the state’s general fund. Along with the fine, Premera must update its provider directories by Oct. 31 to comply with state regulations.
The Washington Office of the Insurance Commissioner fined UnitedHealthcare $500,000 for similar violations in 2023.
Contributing: Heather Bosch, KIRO Newsradio
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