|Addiction Treatment Industry Newswire|
|03/07/2015 -ATIN – It is getting more difficult for those organizations that manage behavioral health and addictions claims to deny coverage as those that have the coverage demand they get something for the premiums they pay, with government agencies representing consumers insisting that these management groups pay settlements to those they feel were improperly denied coverage. According to published reports, New York state’s attorney general’s office has insisted on a $900K settlement from a company that handles addictions and behavioral health claims on behalf of groups of New Yorkers and found that this company was denying addictions and behavioral health claim requests at a rate much higher than denials typically surface for medical surgical type insurance claim payment and coverage requests. This is one very good and recent example of how laws requiring “parity” in claims payment between mental health and addictions and medical surgical are beginning to be enforced more rigorously.
States Moving to Introduce Legislation
Legislators in some states like New Jersey have moved recently to introduce legislation that would put more of the absolutely critical utilization review decision about who gets care and what type, if any, into the hands of the medical services providers, including addiction treatment centers, psychiatrists, medical directors and even social workers. Pennsylvania has long had legislation like this on the books and it’s one of the reasons an addiction treatment “hub” has arisen in the eastern part of the state with treatment centers like Clarity Way, The Retreat at Lancaster and others.
There Should Be No Difference between Claims
New York Attorney General Eric Schneiderman said in a prepared statement, according to published reports, that there should be no difference and it shouldn’t be any more difficult to get coverage and claims approved for those seeking help for addictions and mental health than for those seeking medical surgical coverage and he proved it this week by demanding that firms that manage behavioral health and addictions benefits behave accordingly.
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