Insurance and Safety Fire Commissioner John F. King announced plans to fine health insurance companies in Georgia more than $20 million for violations of the state’s Mental Health Parity laws.
“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,” said Commissioner King.
The Mental Health Parity Act of Georgia works together with the federal Mental Health Parity and Addiction Equity Act of 2008. Both require insurers to provide mental health and substance use disorder coverage equal to physical health coverage. The Insurance Commissioner’s office oversees private insurer compliance, including annual reviews of insurer data, processes, strategies for benefit applications, and non-quantitative treatment limitations.
Each year by May 15, the office must conduct a data call to assess compliance with parity laws. A report is published on August 15. If potential violations are found, market conduct examinations are started to check if mental health parity requirements are being met.
The first mental health parity data call report was released on August 15, 2023. Findings led the Office of Commissioner of Insurance (OCI) to begin market conduct examinations against twenty-two insurers. These audits examine an insurer’s business practices in detail and can take months or years depending on their complexity.
Initial examinations found over 6,000 violations related to mental health parity laws. Violations included inconsistent identification and application of benefit classifications; applying prior authorization for services not listed as requiring it; using concurrent review authorization where not required; and reprocessing claims after unclear post-service medical necessity reviews.
According to state law (O.C.G.A § 33-1-27(i)), penalties may be up to $2,000 per violation or up to $5,000 if it is determined that an insurer knew or should have known about the violation. Insurers who do not comply may also be placed under a compliance plan or ordered to reprocess claims.
“The time to get in compliance with the law was yesterday,” Commissioner King remarked about the fines. “Today, we are taking decisive action to hold those who think they can skirt the law accountable. I will not tolerate games, excuses, or stalling tactics from these companies, and we will come after those who try with every tool at our disposal.”
The OCI stated it will continue oversight through corrective actions and enforcement as allowed by state law. Consumers suspecting a violation can file complaints online or call toll-free at 1-800-656-2298.
###
