‘An injustice to the public’: Premera Blue Cross penalized for failing to comply with mental health coverage rules

Premera Blue Cross Faces Fines for Regulatory Violations

Premera Blue Cross Washington is looking at fines exceeding $500,000 from the Insurance Committee’s Washington Office. This action is a result of breaches related to the Mental Health and Addiction Equity Act, as well as the state’s Provider Directory regulations.

Patty Koederer, a member of the insurance committee, noted that mental health care has not adhered to the mandated coverage rules. In Washington, mental health services are required to be treated equally to physical health services. Investigators discovered that Premera struggled to maintain this balance and failed to provide documentation comparing the limits of mental health and physical health coverage.

“These violations impact individuals who depend on Premera’s health plans,” Koederer stated. “Our laws exist to guarantee that mental health services are just as accessible as any other health services. We will continue to hold companies accountable that do not follow these regulations.”

The concept of balanced coverage implies that if a hospital provides unlimited visits for a chronic physical condition, it must also offer the same coverage for chronic mental health conditions.

Furthermore, Premera did not consistently update its provider directory for gender-affirming care on a monthly basis. The directory for gender-affirming treatments was noted to be last updated on “as of December 7th, 2021.”

Premera Blue Cross Responds to Fines

In comments made to Kiro Newsradio, Courtney Wallace, a spokesperson for Blue Cross, mentioned that health insurance companies are working to update their directories. This effort aims to clarify which providers offer gender-affirming care, outline access to Telehealth services, and specify if referrals are required for certain services.

“We remain committed to providing clear, comprehensive, and current information to support our members’ healthcare experiences,” Wallace said.

She also indicated that Premera hopes to finalize the updates by October and that there are no plans to contest the fines with the state.

The funds from Premera’s fines will go to the state’s general fund. Along with the financial penalty, the company is required to update its provider directory by October 31st to align with state regulations.