New Hampshire’s insurance department published its preliminary findings Feb 19 of its probe of the state’s insurers, checking whether the companies are properly covering substance abuse treatment. The probe discovered considerable differences in how often claims are denied, but the agency found that there were only glaring issues with some of the cases.
According to the report, there were 11,650 claims in total for opioid treatment filed between Jan. 2015 and Oct. 2015 for Anthem Blue Cross and Blue Shield, Cigna, and Harvard Pilgrim—the region’s top three insurers. The report also noted that across the board, the number of patients filing for such claims represented less than half of one percent of each company’s customers.
The denial rates of opioid treatment claims of the three insurers were 9.5%, 15%, and 28.3%—the companies were not identified individually.
The medical experts in charge of the probe found that of the 64 cases they screened in which treatment was deemed medically unnecessary, only eight had legitimate concerns.
Deputy Insurance Commissioner Alex Feldvebel said that of the eight, most were not outright denials but featured disputes about the level of care requested.
“We think maybe there’s a lack of understanding about the need for short-term inpatient withdrawal management services versus indefinite inpatient treatment,” Feldvebel added.
The probe also reviewed each insurer’s provider network and the appeals process made available to consumers. The northernmost county of Coos experienced difficulties with its insurance services, but southern counties such as Rockingham and Hillsborough fared much better.
The probe noted that there were no problems with the appeals processes of the insurers, but noted that few consumers actually used them. Correspondingly, the insurance department received only a handful of complaints or requests for external reviews related to substance abuse treatment insurance coverage in the last few years.
“There may be a no more health literacy-challenged population than someone in the throes of an active behavioral health disorder,” remarked commission chairman Timothy Rourke regarding the findings. “It can be an overwhelming situation, and for this population even more so.”
New Hampshire’s insurance department will continue its probe and will prepare a final report next summer.
