Two states took action last week to address potential parity violations by insurers that limit access to mental health and substance use disorder (MH/SUD) care.

Nevada annual report: A Nevada Division of Insurance report found that at least 16 insurance carriers in the state likely violated federal parity law last year.

• The details: It found that carriers required prior approval for benefits that were not publicly listed as needing it; had higher denial of claims for MH/SUD treatment than medical services; had less robust provider credentialing for MH/SUD than for medical care; and documented lower reimbursement rates for MH/SUD than for physical health claims.
• Next steps: State law does not prescribe any initial penalties for the insurers and requires additional investigation through a market conduct exam, which will likely extend into 2027. Once those findings are in, the state can take enforcement action such as fines up to $50,000.

New York/EmblemHealth settlement: EmblemHealth, one of NY’s largest health insurers, agreed to a $2.5 million settlement with the state attorney general’s office for failing to fix inaccuracies in its listings of in-network mental health providers.

• The details: The attorney general’s office found that EmblemHealth overstated the availability of in-network mental health providers and failed to comply with state and federal parity laws. Most of the providers listed in EmblemHealth’s directory that the office tried to call were not available for an appointment. Hundreds of customers had issued complaints about errors in the past several years, but EmblemHealth failed to address the issue, even though it had promised to do so as part of a 2011 settlement.
• Next steps: The insurer agreed to compensate customers who paid out of pocket for care because they could not secure an appointment with a provider listed as in network. It pledged to correct inaccurate listings within 2 business days of being made aware of an error and to check every 90 days that each listing is accurate.