By Forum Staff
The State Attorney General’s Office has reached a settlement with Cigna, requiring the health service company eliminate a written ban on coverage for claims for neuropsychological testing of psychiatric conditions and autism spectrum disorder, NY Attorney General Eric Schneiderman announced on Monday.
Cigna will also reprocess denied claims for autism spectrum disorder, Schneiderman added.
According to the attorney general, his Office’s Health Care Bureau launched an investigation into Cigna’s administration of mental health benefits following a complaint in 2016 about its written policy for neuropsychological testing. The policy said that “Cigna does not cover neuropsychological testing” for psychiatric conditions and autism spectrum disorder “because such testing is considered educational in nature and/or not medically necessary.”
“Insurers must provide the same access to mental health services as they would for any other treatment. We will continue to aggressively enforce our health care parity laws to ensure that no New Yorker faces illegal barriers when seeking mental health treatment,” Schneiderman said.
Under the terms of the settlement, the company agrees to comply with Timothy’s Law, New York legislation enacted in 2006 and named for 12-year-old Timothy O’Clair who committed suicide after an insurance company denied ongoing coverage for treatment of serious mental health issues.
According to the O’Clair family, Timothy hanged himself in his bedroom closet in March 2001 after he “and his family spent nearly five years seeking the necessary treatment and services for his emotional disorder.” Timothy’s parents, Tom and Donna, said that whenever they sought help for their son, they “ran into barriers”: limits on coverage under insurance policies for mental health and substance abuse services.
“It is Tom and Donna’s belief that had their health insurance policy provided equal coverage for mental health and chemical dependency services, as are provided for other health services, Timothy would be here today,” the family said.
Prior to the enactment of Timothy’s Law, the O’Clairs noted, “every private insurance policy in New York limits the amount of inpatient and outpatient coverage provided for mental health and substance abuse services or requires additional co-payments from the insured. Simply put, these policies discriminate in the coverage they provide based upon diagnosis of mental illness or substance abuse disorder.”
Timothy’s Law, Schneiderman said, mandates that New York group health plans provide “broad-based coverage for the diagnosis and treatment of mental, nervous or emotional disorders or ailments … at least equal to the coverage provided for other health conditions.” The New York law is similar to federal mental health parity laws, which were passed in 2008, the AG noted.
The settlement requires Cigna to revise its policies, pay autism claims previously rejected, and pay a penalty of $50,000. Cigna also clarified its policy regarding concussion and mild cognitive impairment. Cigna shall also provide coverage information to its members and members’ health care providers upon request, according to the attorney general.
Schneiderman also advised consumers with a complaint regarding health insurance coverage for mental health, or any other health care-related complaint, to contact the Attorney General’s Office Health Care Helpline at (800) 428-9071.