🔒State to fine 5 major insurers for violating mental health parity laws

Connecticut insurance regulators plan to fine the state’s five largest health insurers an undisclosed amount for failing to comply with mental health parity laws, citing numerous shortcomings that limit access to care for patients seeking behavioral health treatment. In a report dated April 15, the state Department of Insurance said the major carriers operating in the state — Aetna, Anthem, Cigna, ConnectiCare and UnitedHealthcare — were not in compliance with requirements governing how insurers manage mental health and substance use disorder benefits. The report states the agency will impose financial penalties on each of the insurers but does not disclose specific fine amounts. A department spokesperson said "enforcement actions have not been finalized yet." "The department is in the process of reviewing each matter and engaging with the affected carriers," the spokesperson said. "Consistent with our standard administrative process, any penalties will be determined based on the specific facts and circumstances of each case, including the nature, severity, and duration of the violations, as well as prior compliance history. Additional details will be made available once those actions are finalized." The report’s findings stem from the department’s annual review of so-called nonquantitative treatment limitations, or NQTLs, which include practices such as prior authorization, reimbursement rates and provider network design. Federal and state laws — including the state Mental Health Parity Act approved in 2019 — require health insurers to apply those standards no more restrictively to mental health care than to medical and surgical services. Regulators concluded that none of the insurers adequately demonstrated that their policies met the standard. The report identified several systemic issues among all five carriers, including lower reimbursement rates for behavioral health providers, higher reliance on out-of-network care and reduced availability of in-network clinicians accepting new patients. Those factors contributed to longer wait times and diminished access to treatment, the department said. Insurers also failed to provide sufficient data and analysis to justify differences in how mental health benefits are administered, the report states. In many cases, insurance companies did not link adverse outcomes — such as network gaps or delays in care — to specific management practices, a key requirement under parity rules. The department said the deficiencies point to broader operational problems rather than isolated compliance gaps. Last year, the state legislature passed regulations to enforce the Mental Health Parity Act, including publicly requiring available scorecards for insurers based on their coverage of mental health services and fines for those who violate the law. Comptroller Sean Scanlon, who helped to pass the 2019 state law while serving as a state representative, said he is glad to see insurers being held accountable. "Diseases of the brain should never be covered differently by insurance than diseases of the body," he said. Editor's note: This article was updated to reflect that the state has not yet determined nor imposed the fines against the insurers.