Healey, 7 firms sign $1m mental health settlement

AG says too many patients ‘have to jump through hoops’

ATTORNEY GENERAL MAURA HEALEY announced a settlement on Thursday with five health insurers and two behavioral health firms, dismissing alleged violations of mental health parity laws in return for $1 million to support improved access to behavioral health services.

The companies charged with violating the federal Mental Health Parity and Addiction Equity Act are Harvard Pilgrim, Fallon, and AllWays.

Healey accused the companies of failing to full reimburse mental health care providers. She separately accused other companies, including Blue Cross Blue Shield of Massachusetts of keeping inaccurate provider directories, and requiring prior authorization for routine behavioral health office visits.

Healey described one patient who suffered from chronic depression being cut off from weekly therapy visits because her insurance company said she wasn’t making measurable progress toward her goals. “That’s not the way this is supposed to work,” said Healey.

Another patient had a major depressive disorder episode and couldn’t navigate a website to find a provider who would take him and couldn’t get his insurer to cover any services.

“People shouldn’t have to jump through hoops in order to get coverage for mental health care,” Healey said during a press conference at Boston Medical Center. “They shouldn’t have to be forced to go out-of-network or pay out-of-pocket because our system unfortunately has been designed in a way or at least has resulted in a way where there’s disparate treatment between how we treat behavioral health and how we treat physical health.”

In the Bay State, she said, 16 percent of mental health providers don’t accept any private insurance.

Five assurances of discontinuances were filed Thursday in Suffolk Superior Court that involved seven companies, including Blue Cross Blue Shield of Massachusetts and Tufts Health Plan. The firms have agreed to either update their provider lists or make changes to reimbursement policies for outpatient mental health services. Healey said the changes will mean an expansion of behavioral health services for more than a million residents.

The settlement alleges that Harvard Pilgrim, AllWays, and Fallon had all under-reimbursed for outpatient behavioral health services far more often than they did for comparable physical health services.

A 2019 study by Milliman analyzing payment rates and billing codes showed that primary care physicians in Massachusetts are paid 60 percent higher than behavioral health providers when providing comparable services using the same billing codes. Behavioral health providers cite the low reimbursement rates as a reason why they don’t accept insurance.

All seven firms agreed to improve the information and accuracy of their online provider directories.

In a statement, Harvard Pilgrim said it did not agree with Healey’s allegations over reimbursement rate disparities with behavioral health providers, but it agreed to the settlement anyway.

Blue Cross Blue Shield of Massachusetts said it believes it has been compliant with the law and has not engaged in any unfair or deceptive practice. The company, however, said it agreed to add staff to improve provider directory accuracy and made changes to health plans to improve access to behavioral health treatment.

“Some of the steps we’ve taken include removing requirements for referrals, notifications, or authorizations for most outpatient psychotherapy and providing access to on-demand counseling and psychiatry through the Telehealth benefit,” said a spokesperson.

A Blue Cross Blue Shield of Massachusetts Foundation study in 2018 found over 39 percent of those surveyed went without necessary behavioral health treatment in the previous year because providers didn’t accept their insurance.

“Thousands of our residents we know struggle with substance use disorder. Thousands are dealing with real issues of anxiety and depression,” said Healey. “Yet for half of Massachusetts adults, it’s really hard to find a specialist to provide the kind of treatment and therapy that they need.”

AllWays Health Partners said it will work with Healey’s office to implement the recommendations. Similarly, Beacon Health Options says it will take the necessary steps to make sure its policies and procedures are in compliance with federal and state mental health parity regulations.

Meet the Author

Sarah Betancourt

Reporter, CommonWealth

About Sarah Betancourt

Sarah Betancourt is a long-time Latina reporter in Massachusetts. Prior to joining Commonwealth, Sarah was a breaking news reporter for The Associated Press in Boston, and a correspondent with The Boston Globe and The Guardian. She has written about immigration, incarceration, and health policy for outlets like NBC, The Boston Institute for Nonprofit Journalism, and the New York Law Journal. Sarah has reported stories such as a national look at teacher shortages, how databases are used by police departments to procure information on immigrants, and uncovered the spread of an infectious disease in children at a family detention center. She has covered the State House, local and national politics, crime and general assignment.

Sarah received a 2018 Investigative Reporters and Editors Award for her role in the ProPublica/NPR story, “They Got Hurt at Work and Then They Got Deported,” which explored how Florida employers and insurance companies were getting out of paying workers compensation benefits by using a state law to ensure injured undocumented workers were arrested or deported. Sarah attended Emerson College for a Bachelor’s Degree in Political Communication, and Columbia University for a fellowship and Master’s degree with the Stabile Center for Investigative Journalism.

About Sarah Betancourt

Sarah Betancourt is a long-time Latina reporter in Massachusetts. Prior to joining Commonwealth, Sarah was a breaking news reporter for The Associated Press in Boston, and a correspondent with The Boston Globe and The Guardian. She has written about immigration, incarceration, and health policy for outlets like NBC, The Boston Institute for Nonprofit Journalism, and the New York Law Journal. Sarah has reported stories such as a national look at teacher shortages, how databases are used by police departments to procure information on immigrants, and uncovered the spread of an infectious disease in children at a family detention center. She has covered the State House, local and national politics, crime and general assignment.

Sarah received a 2018 Investigative Reporters and Editors Award for her role in the ProPublica/NPR story, “They Got Hurt at Work and Then They Got Deported,” which explored how Florida employers and insurance companies were getting out of paying workers compensation benefits by using a state law to ensure injured undocumented workers were arrested or deported. Sarah attended Emerson College for a Bachelor’s Degree in Political Communication, and Columbia University for a fellowship and Master’s degree with the Stabile Center for Investigative Journalism.

For Marylou Sudders, the state’s secretary of health and human services, the situation is personal. Sudders said her own family has three generations that have struggled with behavioral health, and she herself has helped pay out of pocket for mental health services.

“Between the efforts of the Attorney General, the Governor’s health care bill, the commitment of the House to address behavioral health, and the Senate’s recently released bill on behavioral health, we stand together in our state once and for all that behavioral health is health care and that long standing barriers must come down,” Sudders said.