’60 Minutes’ Spotlights Insurance Denials For Mental Health

California fights back through legal action, regulation

December 16, 2014

California Insurance Commissioner Dave Jones has commended CBS “60 Minutes” for highlighting the difficulties individuals experience in securing longterm mental health coverage and highlighted his agency’s efforts to improve benfits, particularly for the treatment of autism.

The CBS segment, entitled “Denied,” [view below] aired December 14 and focused on claims processed by Anthem. CBS found that 90 to 100 percent of claims reviews were denied by Anthem’s contracted physicians.

“60 Minutes highlights Anthem Blue Cross’ history of denying coverage for vital mental health treatment despite mental health parity laws, but they are not the only insurer that has denied coverage for lifesaving care to those who suffer from mental illness,” said Jones. “If a patient is denied medically necessary care, such as residential care for an eating disorder or behavioral health treatment for autism, the Department of Insurance is here to help the policyholder get the coverage they are entitled to under the law. This 60 Minutes feature puts a national spotlight on the all too common practice of denying people with severe mental illness the medical care to which they are entitled.”

In April, Jones’ agency issued strict guidelines on the behavioral health treatment for autism, such as applied behavioral analysis (ABA), that insurers must cover. Prior to the new regulations, it was not uncommon for health insurers to delay or deny medically necessary treatment for individuals with autism.

“The mental health parity regulations will help end improper insurer delays and denials of medically necessary treatments for people with autism,” said Jones. “This regulation provides clear guidance to the industry, stakeholders and consumers on the requirements of the Mental Health Parity Act.”

Autism Speaks honored Jones as its 2014 Executive Champion for his strong advocacy on behalf of families with autism during the 9th Annual Autism Law Summit.

As a result of a string of class action lawsuits brought in Washington state, coverage for autism has now been required by regulation by all state-regulated health plans. The litigation was all based on alleged violations of state and federal mental health parity law.




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