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State’s record for enforcing insurance mandate questioned

Regulator pushes back, says Ohio is aggressive in chasing down complaints.

Insurance companies are required by federal law to cover mental health and drug addiction issues on par with physical illness, but some advocates for mental illness don’t give Ohio high marks for enforcing the law.

“Their approach has been very much hands off: If consumers aren’t telling us there’s a problem, there must not be a problem,” said Tim Clement, senior policy advisor at The Kennedy Forum, a mental health advocacy group. He gives the state’s regulators a C-minus for their enforcement efforts on the parity law, which was greeted as landmark legislation when it passed in 2008.

Ohio’s approach has come under a spotlight because of the state’s high death rate due to opioid addiction, which advocates say would be reduced if people had access to more mental health and addiction treatment.

It also has political significance, at least in the May 8 Republican primary for governor. Lt. Gov. Mary Taylor, who is running for governor in the primary against Attorney General Mike DeWine, was responsible for enforcing the law until her resignation as insurance commissioner last year.

Taylor declined to comment for this story, but Jillian Froment, who Gov. John Kasich appointed as director, pushed back against critics who say the department isn’t doing enough.

Related: Lt. Gov. Mary Taylor’s sons fighting opioid addiction “I think that Ohio and the department really does a good job in enforcing health insurance law, specifically mental health parity law,” she said. “It starts from the moment insurers walks through the door with a product they want to sell.”

But some advocates say other states are far more aggressive.

“This is such a confusing law. To expect consumers to flood the phone lines with complaints about parity is unrealistic, particularly considering according to a survey by the American Psychological Association only 4 percent of the public even know about this law,” Clement said.

Aggressive states

Over the past several years, New York Attorney General Eric Schneiderman sued and reached settlements with eight health insurers for wrongly denying coverage for mental health issues and drug treatment, resulting in millions of dollars in fines, reimbursements and restitution as well as changes in business practices.

Ohio was also not one of the 19 states that in 2016 applied for and received grants to help enforce the party law.

Froment said the department didn’t apply because it doesn’t like going after one-time money.

Related: Report: Ending ACA may leave many Ohioans without mental health care The federal Mental Health Parity and Addiction Equity Act was adopted and signed into law by President George W. Bush in 2008. Two years later, the Affordable Care Act extended its reach to include individual and small group insurance plans. The law, which is enforced by the states, requires health insurance plans to provide comparable coverage for mental health issues, drug abuse disorders and physical ailments. The co-pays, deductibles, treatment limitations, inpatient and outpatient services need to be on par. Likewise, prior authorizations, medical necessity reviews and other steps must be handled in a similar fashion for mental and physical issues.

The law impacts large swaths of the public. In a given year, 43.8 million adults — or one in five adults — experience mental illness and or substance abuse disorders, according to the National Alliance on Mental Illness.

Froment said her staff review insurance products for compliance, investigate consumer complaints and look for systemic problems. The state receives very few complaints, she said.

“What we see, typically, are case by case specific issues with individual consumers. We have not identified a systemic issue and I think that’s in large part because we do a great job upfront in making sure the policies and the products being sold here are compliant,” she said.

Treatment obstacles

The Ohio Council of Behavioral Health & Family Service Providers and 13 other advocacy groups are participating in a national ‘Parity at 10 Campaign,’ a push to get Ohio and other states to do a better job enforcing the law.

Lori Criss, chief executive of the Ohio Council, said the small number of parity complaints in Ohio are at odds with a national report from Milliman, a research and actuarial firm, that found Ohioans face persistent obstacles to accessing mental health and drug treatment care under their insurance plans.

“As the state faces an unrelenting opioid epidemic, we urge the Ohio Department of Insurance to redouble its consumer education and enforcement efforts so that people can access the health care they are entitled to and often paid for,” Criss said.

Related: Ohio uses marketing muscle to push new crisis text line Of mental health advocates critical of her department, Froment said: “Please send your consumers to us. Please get us actual incidents and facts, because we want to know about them. We want to act on them.”

But Clement said it’s unrealistic to expect consumers — many of them facing drug addiction or mental health issue — to understand whether denial of coverage is a violation of federal law.

“Given the scope of the issue, I find it hard to believe that there aren’t more people having problems with their insurance coverage for mental health and addiction treatment, particularly addiction treatment in Ohio considering how the state has been ravaged by the opioid crisis,” he said.

Since 2011, 17,082 Ohioans have died of opiate overdoses while another 11,371 died by suicide, according to Ohio Department of Health data.

Just recently, Ohio Department of Insurance updated its website with more clearly stated information about what the parity laws require and how to make a complaint via the department’s consumer hotline, 800-686-1526. It also posted a 10-page report documenting its efforts to educate consumers and enforce compliance by insurers.

Related: Ohio launches campaign to prevent youth suicide Those steps were mandated by a June 2017 change in state law that state Rep. Mark Romanchuk, R-Mansfield, got inserted into the state budget bill.

Romanchuk said as the state grapples with an opioid epidemic, it’s vital that consumers maintain insurance coverage and have access to mental health or addiction treatment.

He also said the state has a financial stake.

“If they spiral down and lose their commercial insurance, of course, the default insurance is Medicaid,” he said.

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