ValueOptions to Pay $900,000 to Settle Wrongful Denial Case

Beacon Health Options — formerly ValueOptions — which administers behavioral health benefits for approximately 2.7 million New Yorkers – will pay $900,000 and dramatically reform its claims review process to settle allegations of widespread violations of mental health parity laws by the company.


An investigation by the New York Attorney General’s Health Care Bureau found that ValueOptions issued denials twice as often for behavioral health claims as insurers did for other medical or surgical claims and four times as often for addiction recovery services.

“Insurance claims for mental health care should be treated just the same as insurance claims for physical health care, and my office will continue to ensure full compliance with our state’s mental health parity laws,” said Attorney General Eric Schneiderman. “The millions of New Yorkers who need mental health and addiction services should never feel shame or stigmatized and my office will remain committed to eliminating barriers to patients getting the care they need.”

Last year, the Attorney General entered into settlements with two major New York health insurers, MVP Health Care and EmblemHealth, which uses ValueOptions as a vendor for administering behavioral health benefits.

These three settlements together require extensive reforms in ValueOptions’ claims management procedures, and require the company to cover residential treatment and charge the lower, primary care co-payment for most outpatient visits to mental health and substance use disorder treatment providers.

New York’s mental health parity law, known as Timothy’s Law, was enacted in New York in 2006, and requires that insurers provide mental health coverage at least equal to coverage provided for other health conditions.

The federal Mental Health Parity and Addiction Equity Act, enacted in 2008, prohibits health plans from imposing greater financial requirements or treatment limitations on mental health or substance use disorder benefits than on medical or surgical benefits.

Every year, almost one in four New Yorkers has symptoms of a mental disorder, but less than half of those people receive treatment. And, despite the fact that in any given year, one in ten New Yorkers has a substance use disorder, only 11% of these individuals receive any treatment.

Lack of access to treatment for vulnerable individuals, which may be caused by health plans’ coverage denials, can disrupt work, family, and school life, and lead to more serious illness. T

he Attorney General’s investigation revealed that ValueOptions consistently applied more rigorous – and frequent – utilization review for behavioral benefits than is typically applied to other medical or surgical benefits.

Denials were nearly twice as common for mental health claims than for other medical claims submitted to insurers, and claims for addiction recovery services were nearly four times as common.

Copyright © Corporate Crime Reporter
In Print 48 Weeks A Year

Built on Notes Blog Core
Powered by WordPress