Georgia Insurance and Safety Fire Commissioner John F. King announced fines totaling more than $20 million against health insurance companies for violating state and federal mental health parity laws that require equal coverage for mental health and physical health services.
What’s Happening: State regulators found more than 6,000 violations after examining 22 insurance companies. The violations happened despite a 2022 Georgia law requiring insurers to cover mental health and substance use disorder treatment the same way they cover physical health care.
What’s Important: The Mental Health Parity Act of Georgia works with the federal Mental Health Parity and Addiction Equity Act of 2008 to require equal treatment coverage. The Georgia Insurance Commissioner must review insurer data every year by May 15 and publish a report by August 15. The first report came out August 15, 2023, and triggered the examinations that found the violations.
Common Violations Found:
- Insurers applied benefit rules inconsistently
- Prior authorization was required for services not listed as needing approval
- Concurrent review authorization was applied to services not identified as requiring it
- Claims were reprocessed for medical necessity reviews without clear reasons
The Penalties: Georgia law allows fines of up to $2,000 per violation. If the insurer knew or should have known about the violation, fines can reach $5,000 per violation. Insurers may also be placed under compliance plans or ordered to reprocess claims.
What Changed: The Georgia Mental Health Parity Act became law in 2022. It gave the Insurance Commissioner authority to conduct annual data reviews and market conduct examinations. Market conduct examinations are comprehensive audits of an insurer’s business practices that can take months or years depending on company size and complexity.
The Quote: “I was there when Georgia’s Mental Health Parity Act was signed into law in 2022. Three years later, our initial examinations show that insurers have turned a blind eye to the rules and continue to deprive Georgians of the essential behavioral health resources they deserve,” King said.
For Consumers: People who believe they experienced a mental health parity violation can file a complaint at the Office of Commissioner of Insurance website or call 1-800-656-2298 toll-free.
“Integrity means doing the right thing even when no one is watching. Somewhere along the way, too many people decided that rule was optional.”
