Rhode Island issues fine to health insurance carrier – KPVI News 6

(The Center Square) – An insurance carrier has been fined for not providing adequate treatment for substance abuse disorders, state officials said.

The Office of the Health Insurance Commissioner said UnitedHealthcare has been fined $100,000 for not using criteria outlined by Rhode Island law for determining levels of care for substance abuse disorder treatment. The health insurer will also have to follow a set of criteria to become compliant.

“Rhode Island is committed to improving access to behavioral health care and substance use disorder treatment,” Gov. Dan McKee said in a statement. “Now more than ever, it is critical that our administration hold health care entities accountable for ensuring parity between physical and behavioral health care. Rhode Islanders deserve fair and adequate access to the care they need, and our administration will continue to ensure that happens.”

The office, according to the release, has stepped up efforts to ensure residents have access to behavioral and physical health care services in the state through conducting examinations of insurance company’s practices to determine if they are following state law.

Maria Gordon-Shydio, communications director for UnitedHealthcare, said the company is working with the state on the matter.

“We are committed to supporting the health needs of our members,” Gordon-Shydio said in an emailed statement to The Center Square. “We worked with the state to address its concerns and continue to enhance processes to better address concerns when they arise. We look forward to collaborating with the state to ensure Rhode Island residents have access to the appropriate care they need to get and stay healthy.”

Under Rhode Island law, all health insurers must follow guidelines from the American Society of Addiction Medicine, which is designed to establish results-based care for addiction treatment.

The office’s review of the insurance company showed “coverage criteria for levels of care of substance-use disorder treatment for 2015 through 2018 were materially inconsistent” with the criteria set under state law, according to the release.

The review also showed that coverage decisions for members would have been affected in a manner that “clinically inappropriate coverage decisions” were made, according to the release.