For Consumers

Kreidler: Court decision bolsters new rule on mental health benefits for families

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October 13, 2014

OLYMPIA, Wash. - Washington’s Supreme Court dealt a huge win to families struggling with their insurers over mental-health coverage with a decision that requires insurers to cover medically necessary neurodevelopmental therapies to treat mental health conditions, including autism.

The ruling clarifies that health insurers cannot exclude coverage of neurodevelopmental therapies when they are medically necessary to treat a mental health condition. Neurodevelopmental therapies include treatments such as occupational, physical, and speech therapies.

“I’m pleased the court ruled for consumers,” said Insurance Commissioner Mike Kreidler. “Its ruling is great news for everyone who fought on behalf of equal treatment for mental-health services in health insurance. It also helps solidify our current efforts to enhance our mental-health parity law.”

The insurance commissioner’s office initiated rule making on mental-health services (PDF, 127KB) two years ago. Last week’s ruling only strengthens Kreidler’s proposal, which is scheduled for a public hearing at 9:30 a.m., Nov. 5, in Tumwater (PDF, 127KB).

Kreidler’s proposed mental-health parity rule (PDF, 127KB), which also extends to chemical dependency disorders:

 

  • Outlines standards for measuring parity between mental-health and medical or surgical benefits.
  • Eliminates blanket exclusions for mental health services.
  • Forbids insurers from excluding services solely on the basis of a child’s age.

 

Kreidler’s office is also building a public database of all health benefit denials by insurers to gather data for tracking trends in access to mental-health coverage.

“I expect all health insurers to comply with the court’s ruling,” said Kreidler. “To ensure that they do, we will conduct a thorough review of all health plans approved by my office for 2015 to make sure none inappropriately exclude neurodevelopmental therapies. If we find any that do, we will take appropriate enforcement measures to ensure consumers get access to the care they’re entitled to.”

Any consumer who believes they are being wrongly denied access to mental-health services should contact Kreidler’s Insurance Consumer Hotline at 800-562-6900 or file a complaint.