Attorney General Maura Healey said Thursday that she has reached landmark agreements with five Massachusetts health insurers over allegations that they created barriers for patients in need of mental health treatment.
The agreements, which require insurers to change the way they pay for mental health treatment and to update the information they provide to members, should make it easier for Massachusetts residents to access needed care, Healey’s office said.
The settlements come after years of investigation into whether insurance companies were complying with mental health parity laws, which require insurers to treat mental health benefits the same way they treat those for physical health.
Healey’s office said three insurers — Harvard Pilgrim Health Care, Fallon Health, and AllWays Health Partners — were violating the law by using different processes to set payment rates for mental health providers than for other providers.
This resulted in especially low payment rates for mental health providers and discouraged providers from participating in insurance networks, the attorney general said.
Many mental health providers in Massachusetts don’t accept insurance, forcing patients to pay out of pocket or go without care.
“People shouldn’t have to jump through hoops in order to get coverage for mental health care,” Healey said at a news conference Thursday.
Harvard Pilgrim, Fallon, and AllWays agreed to change their internal processes for setting payment rates. The three companies also agreed to limit prior authorization requirements that the attorney general’s office called unjustifiable.
Fallon, through its mental health benefits administrator, Beacon Health Options, will no longer require patients to receive permission before routine mental health appointments, or for mental health admissions after treatment in a hospital emergency department.
Harvard Pilgrim and AllWays, through their administrator Optum, agreed not to overrule health care providers on the type and frequency of mental health treatment they recommend for their patients.
But Harvard Pilgrim officials objected to Healey’s claim that the company violated parity laws. “We do not agree with the Attorney General’s allegations and feel the law does not support their assertions,” they said in a statement.
Harvard Pilgrim has improved access to mental health services by increasing provider payments and expanding networks, among other changes, the statement added.
Insurance industry representatives said insurers have tried faithfully to comply with parity laws but argued the law is too ambiguous.
“Despite best efforts by health plans and state regulators to interpret the federal mental health parity law, the federal government has failed to provide clear and comprehensive guidance," said Lora Pellegrini, president of the Massachusetts Association of Health Plans.
Representatives of AllWays, an insurer owned by Partners HealthCare, were more conciliatory, saying they applauded the attorney general’s leadership and are working with her office to implement changes.
The settlements also require Beacon, Optum, and five insurers — Harvard Pilgrim, AllWays, Fallon, Tufts Health Plan, and Blue Cross Blue Shield of Massachusetts — to improve the accuracy of their provider directories. The companies must audit their directories regularly and make timely corrections when necessary.
These lists of health care providers often contain dated information, leading people to believe that certain providers are in-network and are accepting new patients when in fact they are not. This can be incredibly frustrating for families searching for doctors, psychologists, and other mental health providers.
A 2019 state law also requires insurers to update their provider directories.
Insurers on Thursday acknowledged the importance of directories but said they rely on health care providers to give them accurate information. They said they are already working together to improve their listings through better technology.
“Across the country, maintaining accurate provider directory information is a challenge,” Blue Cross officials said in a statement, adding that they have invested “significant resources” to update provider listings.
In 2018, Healey’s office settled with insurer Aetna after an investigation found that its provider listings were inaccurate and deceptive.
Concerns about access to mental health treatment have existed for years, but the issue has come into particular focus recently on Beacon Hill. The state Senate this month passed a bill that addresses many of the issues in Healey’s settlement. It includes more enforcement of parity laws, eliminates prior authorization requirements for patients having a mental health crisis, and seeks to boost payment rates for mental health providers.
Last October, Governor Charlie Baker introduced health care legislation that would require health care providers and insurers to spend more on mental health care, while containing their overall costs.
Baker’s secretary of health and human services, Marylou Sudders, praised Healey’s settlements with insurers at the news conference Thursday.
“It is time to implement parity for what it is,” Sudders said. "Longstanding barriers must come down.”
State Senator Julian Cyr, cochairman of the Joint Committee on Mental Health, Substance Use and Recovery, said the attorney general’s action “reiterates that mental health parity, and addressing the truly fragmented mental health care delivery system we have in Massachusetts, is a priority.”
In addition to changing practices, the settlements require insurers to pay a combined $1 million in penalties. The agreements were filed in Suffolk Superior Court and do not need a judge’s approval.