Washington, USA – Insurance companies are forced to review mental health denials beginning 2006 and inform their customers about the reconsideration of their claims.
Health insurance companies in Washington state are required to review mental health denials, identifying any policyholder who had been denied of mental health services, considering the January 1, 2006 blanket exclusion. Insurers are also required to notify such policyholders of their rights to the re-evaluation of their claims.
Mental health services are typically for clients with mental health issues or any behavioral conditions, who need urgent care ad immediate treatment. Thus, they obtain insurance plans and policies as their urgent care near me protection or coverage.
Recently, the Supreme Court of Washington State ruled that the State Mental Health Parity Act indicates that insurers are prohibited to use mental health services blanket exclusions since these services might be medically necessary.
Mike Kreidler, insurance commissioner, said the Washington court ruled asserted on behalf of consumers. He intends to see that insurance companies doing business within the state comply with the decision.
Kreidler expects insurers to review mental health denials, thoroughly reviewing all insurance holders who may have past and current claims that were affected by the decision. He also expects that process starts immediately.
Those with mental health and behavioral problems oftentimes visit urgent care clinics for medications or treatments, considering the severity and complications that may occur when such health conditions are ignored.
The Mental Health Parity Act applies to large-employer plans as of January 1, 2006, while as of January 1, 2008, the act applies to individual-employers and small-employer health plans.
Aside from notifying the affected policyholders, the insurance commissioner is also requiring the insurance companies to gather and report in his urgent care clinic. By March 1, 2015, Kreidler wants the state insurers to report to his office on the quantity of notices sent to customers, as well as the number of customers who want re-evaluation of their claims or request an appeal. Reports will also include results of each claim that was re-evaluated.
Plan holders who suspect they are affected by the court’s ruling, or those with queries about their coverage, and have had previous mental health service claims, which were denied, must file a complaint or get in touch with the commissioner’s office.
Policyholders with claims that require re-evaluation or reconsideration should be contacted by their respective health insurers, informing them that the insurer will review mental health denials or any claim by the year-end.
