UHC Will Pay Penalty on Mental, Behavioral Reimbursement Parity

August 16, 2021 - UnitedHealthcare settled a case with the US Department of Labor and the New York State Attorney General regarding the health insurer’s mental and behavioral reimbursement parity, the Department of Labor announced.

The payer and its mental and behavioral healthcare arm, United Behavioral Health, will pay $13.6 million to its beneficiaries and more than $2 million in penalties.

“Plans and insurance companies cannot place special hurdles in the paths of workers and their families when they seek mental health and substance use disorder benefits,” Acting Assistant Secretary for Employee Benefits Security Ali Khawar said in the Department of Labor’s press release. 

“The law requires parity between these benefits and medical benefits. We are committed to vigorously enforcing the law’s requirement and making sure workers in need of help are treated fairly.”

The Employee Benefits Security Administration’s investigation stated that UnitedHealthcare had lowered reimbursement rates for out-of-network mental healthcare providers. Due to this policy, the payer reviewed and denied many beneficiaries’ mental healthcare treatment claims. 

According to the Department of Labor, UnitedHealthcare also failed to forewarn its beneficiaries and health plans about these restrictions.

As a result, this practice—which the administration traced back as far as 2013—placed an excessive amount of financial burden on beneficiaries by overcharging them, the press release argued. It contradicted the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) by creating barriers to mental healthcare services that do not exist for clinical products and services.

“Protecting access to mental health and substance use disorder treatment is a priority for the Department of Labor and something I believe in strongly as a person in long-term recovery,” said US Secretary of Labor Marty Walsh. “This settlement provides compensation for many people who were denied full benefits and equitable treatment.”

The Department of Labor offers health insurance plans a self-compliance tool designed to help health insurers ensure compliance with the MHPAEA and the Employee Retirement Income Security Act of 1974 (ERISA), Khawar noted in his statement.

This resource provides definitions of essential parity terminology and outlines eight questions to help health plans assess their own compliance status. Some questions include tips and examples that may elucidate the more complex issues. The self-compliance tool also addresses special rules on classifications.

In the wake of this investigation, UnitedHealthcare has reiterated its own commitment to reimbursement parity.

“We are committed to ensuring all our members have access to care and to reimbursing providers consistent with the terms of the member’s health plan and state and federal rules,” UnitedHealthcare told HealthPayerIntelligence in an emailed statement. 

“We are pleased to resolve these issues related to business practices no longer used by the company. As part of our broader commitment to quality care, we continue to support our members with increased access to providers and new ways to get the effective behavioral support they need.”

Previously, United Behavioral Health ran into separate legal issues in 2019 related to parity when defendants argued that the insurer’s behavioral healthcare arm pursued reimbursement terms that conflicted with standards of care.

In fact, the Employee Benefits Security Administration’s 2020 report to Congress referenced this case in one of the five points in its Five-Point Mental Health/Substance Use Disorder Enforcement Evaluation Program. The administration updated its information tracking systems in order to account for parity violations that did not fall under MHPAEA.

Behavioral and mental healthcare parity experts assert that payers need to improve their efforts around reimbursement parity. Studies have shown that lack of reimbursement parity for mental and behavioral healthcare is on the rise.

However, alongside these calls for action, experts recognize that payers do face certain challenges in some areas of compliance. For example, MACPAC’s July 2021 report discovered that non-quantitative treatment data collection can be particularly difficult to assess.

Experts have pointed to four data points that payers can track in order to ensure behavioral and mental healthcare parity within their own companies: the percentage of out-of-network mental and behavioral healthcare claims, in-network rates compared to clinical care, mental and behavioral healthcare services denial rates, and network directory accuracy.