March 08, 2016

Senators Introduce Bill to Help Ensure Patient Access to Mental Health Coverage Required by Law

Legislation Would Increase Transparency to Hold Insurers Accountable, Strengthen Consumer Protections

Washington, DC - United States Senators Elizabeth Warren (D-Mass.), Al Franken (D-Minn.), Sherrod Brown (D-Ohio), Richard Blumenthal (D-Conn.), and Tammy Baldwin (D-Wis.) on Monday introduced the Behavioral Health Coverage Transparency Act, which would increase transparency and strengthen accountability for insurers so that patients receive the mental health coverage they are entitled under the law. The legislation is a companion to the House bill previously introduced by Congressman Joe Kennedy III.

"The law is clear:  Americans have the right to equal health care coverage for physical and mental illness, but far too many families face far too many denials from their insurance companies," Senator Warren said. "The Behavioral Health Coverage Transparency Act will help strengthen accountability for insurers and give consumers better tools to get information and submit complaints."

"Like Senator Paul Wellstone, I believe it's vital to do everything we can to recognize mental illness early and treat it effectively," said Senator Franken. "But today, thousands of Americans are being blocked from accessing mental health treatment. And that's unacceptable. Our legislation will make sure that insurance companies are complying with what's called mental health parity, which requires that both mental health and physical health are covered equally. This bill will bring much-needed accountability to companies that provide health care coverage, and it will give a voice to Americans who are being shut out from getting the treatment they need."

"When a loved one is struggling with mental illness or addiction, the last thing they should have to worry about is how to appeal insurance claim denials. They should be able to focus on their recovery - not how to pay for it. We've got to make sure insurance companies follow the law. This means covering mental illness and substance abuse in the same way they cover physical illness so more people can get the affordable mental health care they need," said Senator Brown.

"Sunlight is a powerful deterrent to law breaking - especially when insurers unlawfully deny mental health care coverage. Current law requires parity for mental health and medical benefits, but insurers are rejecting claims for mental illness at nearly twice the rate as claims for physical illness. This critical legislation will close that unacceptable gap by bolstering transparency and requiring periodic audits of health plans to ensure compliance with the law. With a crippling opioid crisis facing our country today, this gap is particularly troubling, because many people who struggle with substance abuse also struggle with depression and anxiety, which are treated through counseling or other behavioral health services. Truly combatting the opioid epidemic requires enforcement of mental health parity," Senator Blumenthal said.

"Far too many individuals with mental health and substance use disorders are still struggling to find insurance that will cover the benefits and treatments they need," Senator Baldwin said. "While we have made historic strides in reducing barriers to mental health care, I hear from too many Wisconsinites who are still regularly being denied health insurance coverage of life-saving services. This critical measure will build on current law and bring stronger transparency, oversight and enforcement of insurance companies so our families get the mental health and substance abuse care they deserve and need."

"Too many Americans suffering from mental illness cannot receive the treatment they need because of barriers in their insurance coverage," said Congressman Joe Kennedy III. "By boosting transparency and giving consumers more information, this bill would ensure insurance providers treat mental health and substance use disorders the same way they would a broken leg or heart disease. As we work to fill systemic gaps in our mental health system, Senator Warren's voice in the Senate will be critical to holding insurers accountable for violations of parity laws."

Federal laws require that insurance coverage for mental and behavioral health care services is on par with the coverage offered for physical health care services, for most plans. However, a survey conducted by the National Alliance on Mental Illness found that nearly 50 percent of respondents had been denied coverage for mental or behavioral health care, compared with only 14 percent denied for physical health care.

The Behavioral Health Coverage Transparency Act requires insurance issuers to disclose to federal regulators how they are making parity decisions, and the rate and reasons for denials of mental health claims. It requires the regulators to conduct random audits of health plans and to make public the results of those audits. Additionally, the bill establishes a Consumer Parity Unit that gives consumers a single place to get information about their rights and to submit complaints with assurance of timely responses. To help improve transparency regarding the compliance of state-regulated insurance plans with parity laws, it also requires state insurance commissioners to collect and disclose information about how the plans under their purview are complying with the law.

A fact sheet about the Behavioral Health Coverage Transparency Act is available here, and the bill text is available here.