Wednesday, October 8, 2014

The Fox Watching the Chickens

On July 9th the office of New York Attorney General Eric T. Schneiderman make the following announcement:

NEW YORK – After an investigation uncovered widespread violations of mental health parity laws by the company, Attorney General Eric T. Schneiderman today announced a settlement with New York City-based EmblemHealth, Inc., requiring the health insurer to reform its behavioral health claims review process, cover residential treatment and charge the lower, primary care co-payment for outpatient visits to mental health and substance abuse treatment providers. The settlement also requires the health insurance plan -- which has 3.4 million members in its HIP and GHI divisions -- to submit previously denied mental health and substance abuse treatment claims for independent review. That review could result in more than $31 million being returned to members wrongfully denied benefits.

An investigation by the Attorney General’s Health Care Bureau found that since at least 2011, EmblemHealth, through its behavioral health subcontractor, Value Options (My bold.), issued 64% more denials of coverage in behavioral health cases than in medical cases. The agreement with EmblemHealth is the third reached by the Attorney General’s office so far this year enforcing the mental health parity laws and stems from a broader and ongoing investigation into health insurance companies’ compliance with the laws.

For the full text of the Attorney General’s announcement – go here:

Today I wanted to learn more about Value Options.  Those that know me understand I have more than a casual interest in their performance and behavior.  The first thing I saw on their website, at the very top of the screen was an announcement about S.O.S. – Stamp Out Stigma. See for yourself here: 

PLEASE correct me if you think I’m wrong.  Value Options, which has clearly demonstrated prejudice against mental health and substance use disorder claims, is now trying to pretend that it wants to end the stigma against mental health and substance use disorder, even as its actions serve to reinforce and perpetuate that stigma by denying proper claims.  The fox is watching the chickens. At the least, Value Options, should say nothing until their practice matches their “policy.”  Until then they come across as the cynical and deceitful business I believe them to be.