Washington Fines Regence $550K for Mental Health Parity Violations
Washington's Office of the Insurance Commissioner has imposed a $550,000 fine on Regence BlueShield for failing to comply with mental health parity laws.
These laws require insurers to provide mental health benefits comparable to coverage for medical and surgical services. Regence did not submit adequate documentation demonstrating compliance with these state and federal regulations, particularly regarding provider network criteria and reimbursement rates for behavioral health care compared to medical care. This ongoing investigation revealed disparities in how Regence reimbursed medical versus behavioral health providers, highlighting accountability issues in adhering to mental health coverage requirements.
The insurance commissioner’s office requested information multiple times from 2019 to 2023, and performed several market reviews and comparative analyses funded by federal grants. Regence’s responses were either incomplete or insufficient, indicating a failure to adhere fully to mental health parity mandates. This enforcement action follows similar fines against Premera and United Healthcare, each sanctioned for parity violations in recent years, reflecting persistent challenges in industry-wide compliance.
Mental health parity laws, initially enacted federally in 2008, have faced enforcement difficulties, with studies indicating frequent insurer noncompliance. For example, mental health patients are substantially more likely to seek out-of-network psychological care compared to specialty medical care, indicating gaps in accessible in-network mental health services. Washington has also received numerous consumer complaints related to coverage denials following prior authorization for out-of-network mental health treatment.
Recent congressional legislation mandates enhanced reporting on insurer compliance with parity rules, though there is some uncertainty about federal enforcement continuity. Washington enforces its own parity regulations, but these protections do not extend to Medicaid recipients or individuals covered under self-funded employer plans, who remain subject to federal rules. Overall, these developments underscore ongoing regulatory attention to ensuring equitable mental health coverage within health insurance markets.