The New Hampshire Insurance Department finds that the state's largest health plans are largely in compliance with state and federal law, but identified a few deficiencies.
As a deadly opioid-abuse epidemic unleashes a public health crisis in New Hampshire, the state's three largest health insurance companies appear to be rising to the challenge, market conduct exams of 2015 data show.
As part of the state government's response to high rates of opioid addiction and overdoses, the New Hampshire Insurance Department (NHID) examined claims data for Indianapolis-based Anthem, Bloomfield, CT-based Cigna Life and Health Insurance Company, and Manchester, NH-based Harvard Pilgrim Health Care of New England.
Addiction Medicine: Building a Bridge From Rescue to Recovery
Claims were reviewed from Jan. 1 to Sept. 30, 2015. Exam findings released March 2 show that the commercial insurance carriers were largely in compliance with state and federal law, but a few deficiencies were identified.
All three companies face calls for corrective action to improve their websites' transparency and ease of access to information about behavioral health and substance use disorder (SUD) coverage.
Harvard Pilgrim was singled out for corrective action over supervision of the company that manages its behavioral health claims, United Behavioral Health/Optum. NHID is set to conduct a follow-up exam of UBH/Optum to determine whether requiring preauthorization for behavioral health services violates federal mental health parity law.
Prior Authorization Still a 'Pain Point' for Providers
The 2015 SUD claims exams give NHID valuable baseline data on insurance coverage of rates of opioid addiction in the state, including thousands of low-income adults who gained coverage through Medicaid Expansion under the Patient Protection and Affordable Care Act, NHID Commissioner Roger Sevigny said in a media statement.
"The reports give us a baseline understanding of insurance companies' practices as we work to ensure that they comply with the law, especially with respect to mental health parity and network adequacy," he said.
The SUD claims exams reviewed seven market-conduct categories:
- Delegated service agreements
- Provider networks
- Prior authorization practices
- Grievances and appeals practices
- Claims and denial volumes
- Medication-assisted treatment protocols
- Adherence to federal mental health parity law
Anthem, Cigna, and Harvard Pilgrim drew criticism over their website capabilities.
For all three insurance carriers, "Examiners had difficulty navigating carriers' websites to find behavioral health/SUD service providers," an NHID exam results overview says.
Anthem and Harvard Pilgrim were ordered to devise corrective action plans to fix their website deficiencies.
The examiners also found the Anthem and Harvard Pilgrim websites deficient in the area of online provider-directory accuracy. NHID is seeking documentation showing corrective action in several online provider-directory capabilities, including the method and frequency of provider-directory verification.
The absence of deficiencies in most market-conduct categories is a positive sign for Anthem, Cigna, and Harvard Pilgrim health plan beneficiaries who are grappling with opioid addiction and other substance abuse problems, Sevigny said.
"I am heartened to see coverage for behavioral health services improving over time in many areas."
Christopher Cheney is the CMO editor at HealthLeaders.