ProPublica is a nonprofit news company that investigates abuses of power. Sign up to receive the biggest stories as soon as they’re published.
The U.S. Department of Labor has found widespread noncompliance and violations of federal law regarding how health plans and insurance companies cover mental health care, findings that echo a recent ProPublica investigation.
A 142-page report released Jan. 17 in conjunction with the Treasury Department found that health plans and the companies that administer them exclude key behavioral treatments, such as drug use and autism treatments, and They say it provides an inadequate network of mental health providers. Department of Health and Welfare.
The report, which insurance agencies are required to regularly submit to Congress, also details the results of a confidential shopper survey of more than 4,300 mental health providers on the insurance directory. It found that an “alarming proportion” were “unresponsive or uncontactable”. ProPublica previously found that such error-filled plans, commonly known as ghost networks, make it difficult for patients to get the treatment they need.
Since 2021, the Department of Labor has been tackling violations in the health insurance system that covers more than 7 million people, according to the report. The agency has sought to rectify the problem by requiring changes to planning regulations, policies and procedures, as well as working to ensure that claims that are unfairly denied are paid.
However, the report acknowledged that although insurance plans and companies have made some progress, they still fall short. For example, federal officials wrote that while insurers worked quickly to fix problems with the plans after they were identified, overall improvements have not been sufficient.
The report examined the implementation and implementation of the federal Mental Health Parity Act and Addiction Equity Act, which require health insurance plans to provide access to mental health care similar to medical insurance. Last week, on the same day the report was released, department staff told ProPublica that the agency was investigating issues related to our report.
Good journalism makes a difference.
Our nonprofit, independent newsroom has one job: to hold those in power accountable. Here’s how our research is driving real-world change.
We are trying something new. Was it helpful?
Over the past year, ProPublica has investigated how insurance companies are interfering with mental health treatment, including employing aggressive tactics to kick therapists out of their networks. Introduce an algorithmic system to limit coverage. Creating a ghost network. Cutting off access to treatment for children with autism. Rely on doctors whose judgment has been criticized by courts. They then use the patient’s progress to justify their denial.
The Department of Labor regulates the insurance plans of approximately 136 million Americans who receive health insurance through their employers and is responsible for enforcing federal protections regarding their mental health claims. Masu. Federal regulators are struggling to hold insurers accountable for unfairly denying mental health coverage, citing staffing and budget constraints.
The agency has repeatedly asked Congress for additional funding, and its most recent Congressional report shows it is left with one investigator for every 13,900 programs it regulates, with more work than usual. It states that the amount is increasing. Some of the temporary funding was depleted in September, the report said, and its “complete depletion would likely have a devastating impact on enforcement capacity.”
In an interview on the same day the report was released, Timothy Hauser, assistant secretary of the Department of Labor, said the agency is investigating the oversight and management of doctors employed by insurance companies that repeatedly deny patients mental health insurance coverage. He said an investigation may be launched. .
Hauser, who has been with the agency for more than 30 years and will remain in the new administration, will discuss how insurance companies use and supervise the doctors they rely on to review coverage, and whether those doctors are The agency is investigating whether cases are being considered from the perspective of A fair and level-headed approach.” ProPublica’s reporting raised serious concerns about these issues.
Last month, ProPublica reported that insurers including UnitedHealth Group, Cigna, Blue Cross and Blue Shield have given doctors the key decision on whether to approve mental health insurance, despite criticism of the court’s decision. We investigated how they depend on each other. The judges ruled that the insurance company’s refusal to provide such coverage violated federal law and acted “incomprehensibly,” “dishonestly,” and even “dishonestly.”
According to court records, some insurance companies and doctors “selectively read” medical evidence, “turn a blind eye” to medical opinion that contradicts their conclusions, make serious errors in their reviews, and sometimes fail to do so at hand. It is said that this was inconsistent with the medical records in the hospital. They said they read it.
Hauser said he could not comment on specific investigations, but said officials have been discussing the ProPublica case, which will influence “the questions we ask” and “the approach we take.” He said he was deaf.
A Ministry of Labor spokesperson previously said that at least one previous investigation led to the dismissal of a doctor and the external review body he worked for.
Insurance companies across the country rely on physicians acting on their behalf to determine whether the treatments sought by a patient’s doctor are medically necessary. If they determine otherwise, they recommend denying insurance coverage, which could put patients in jeopardy and prevent them from receiving the treatment they need. In some cases, such decisions have had fatal consequences.
“It should be done with fairness and not be designed to favor physicians denying claims rather than granting them,” Hauser said. “Similarly, doctors and health care providers should not be singled out because of their propensity to deny claims.”
United Airlines, Cigna Airlines, Blue Cross Airlines, and Blue Shield Airlines did not immediately respond to requests for comment, but in the past they have employed licensed physicians to conduct reviews and ensure that physicians make appropriate coverage decisions. He said he is trying to lower the issue. The companies said they are committed to conducting regular audits of physicians’ decisions, providing mentoring and coaching opportunities, and providing safe, effective and high-quality care to patients.
Hauser said he was struck by Emily Dwyer’s story, which was featured in a ProPublica article examining the role of corporate psychiatrists. She was 15 years old and suffered from severe anorexia. When United Healthcare denied her insurance coverage, she arrived at the residential treatment center wearing her 8-year-old sister’s jeans.
Her mental health treatment helped. That’s why the insurance terminated her coverage.
United Airlines claimed that three separate doctors reviewed her case. The Dwyers sued and lost, but appealed to the Fifth Circuit Court of Appeals, which reversed that decision and ruled unanimously in the family’s favor. In a harshly critical opinion, the judges wrote that the denials issued by the three doctors were “unsupported by basic medical evidence.” In fact, the court found them to be “inconsistent with the record.”
Ms Dwyer said she was pleased to learn of the authorities’ investigation and hoped it would lead to “substantive action”.
“We never thought our story would be a part of it,” she said. “I think it’s incredible that the Department of Labor is paying attention to this issue and investigating insurance doctors. But I also think that beyond the actions of individual doctors, insurance companies are operating more systemically. We also want to look at deeper questions about how things are done.”
