The US Department of Labor has found extensive non -compliance and violations of the federal law in how healthcare plans and insurers cover mental health, conclusions that reflect A recent PROPUBLICA investigation.
Health and companies that manage them exclude key behavioral treatments such as treatments for substances and autism, and offer insufficient mental health networks, according to the 142nd Page report Released on January 17, combined with the Treasury and Health and Human Services.
In a report, which agencies should regularly submit to Congress, also described in detail the results of secret surveys of buyers over 4,300 mental health suppliers included in the insurance catalogs and found that the “alarm” were “not reacted or unavailable”. Such errors plans commonly known as ghost networks, complicate patients to get the necessary treatment, PROPBLICA Previously found.
Since 2021, the Department of Labor has considered violations in health care plans serving more than 7 million people, the report said. The agency worked to eliminate problems, seeking changes in the provisions, policy and procedure, as well as working to pay incorrectly denied requirements.
But the report confessed that, while plans and insurers have made some progress, they continue to miss. For example, federal officials wrote that the insurers were working faster to correct the problems in their plans after they were identified, but officials did not see sufficient improvement overall.
The report studied and implementing the federal law on the parity of mental health and justice of addiction, which requires health insurance plans to ensure the same access to mental health as for medical care. Last week, on the same day the report was released, the department staff stated Propublica that the agency was investigating issues related to our reporting.
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PROPUBLICA spent the last year Investigating how to interfere with insurers with mental health treatment, including employment Aggressive tactics that pushes therapists from the network; deployment Algorithmic system to restrict coverage; creating Ghostly networks; reduction of access to Treatment for children with autism; leaning on doctors whose opinions have been criticized by vessels; and the use of patients’ progress to justify the rejection.
The Department of Labor Regulates insurance plans for about 136 million Americans who receive healthcare through their employers and is responsible for fulfilling federal protection over their mental health requirements. Federal regulators have struggled to account for insurance companies for misconduct of mental health coverage, partly of personnel and budget restrictions.
The agency appealed to Congress of additional financing several times, and in the last report Congress wrote that the agency remains one investigator for every 13 900 plans he regulates, A, A, A A higher load than in previous years. Temporary financing will end in September, and its “complete depletion will probably have catastrophic consequences” on the possibility of fulfillment, the report said.
Timothy Hauser, Deputy Assistant Secretary of Labor, said in an interview on the day of the report that the agency was investigating and management by doctors, hired by insurance companies who repeatedly deny mental health for patients – and may open additional investigations.
Hauser, who worked for the agency for more than three decades and remains in the new administration, said the agency is checking how the insurers use and control the doctors for which they count to conduct reviews and whether these doctors are considering And the hassle “path. The propublica report has caused serious problems around these issues.
Last month PROPUBLICA studied as insurance companiesincluding UnitedHealth Group, Cigna, and Blue cross and blue shieldCount to doctors to make important decisions about whether to approve mental health coverage even after the courts have criticized their decision. The judges decided that by denying such lighting, the insurers violated the federal law and acted as “who were” who “puzzling“” “”insincereAnd even “dishonest“
Some insurers and doctors, according to court records, were engaged “Selective readings“Medical evidence”, “”Close the eye“Medical considerations that opposed their conclusions and made Critical errors In their reviews, which sometimes contradicted the medical documents, they said they read.
Hauser said he could not comment on specific investigations, but stated that the agency’s officials discussed the Proopublica History, which, he said, “would affect the questions we ask” and “the approaches we accept.”
At least one investigation in the past led to the removal of a doctor and an external review organization they worked on, said the press secretary of the department before.
Insurance companies across the country are counting on doctors who work from their behalf to determine whether the treatment of their own patients is needed medical. If they determine that this is not the case, they recommend denying the coating that can leave patients in the crisis and without the necessary treatment. In some cases, these decisions have led to the deadly consequences.
“It must be done with impartiality and without structuring in such a way as to encourage doctors to refuse claims unlike the claims,” Hauser said. “Similarly, doctors and providers should not be chosen from the predisposition to refusals.”
United, Cigna and Blue Cross and Blue Shield did not immediately respond to requests for comments, but in the past they stated that they were using licensed doctors to conduct reviews and work to ensure that doctors have made appropriate security decisions. The companies said they conduct regular checks of doctors, provide mentoring and coaching and seeking access to safe, effective and quality assistance to patients.
Hauser said he was impressed The story of Emily DwyerWhich was presented in the Popublica article, which studied the role of the company’s psychiatrists. She was 15 years old and suffered from heavy anorexia-she arrived at the residential center, which put her 8-year-old sister-in-year-old United Healthcare jeans in her lighting.
United claims that three individual doctors had considered her case. The Duhari sued and lost, but went to the 5th Appeal Court of the United States, which repealed the decision and unanimously managed for the benefit of the family. Based on the critical opinion, the judge wrote that the refusal issued by three doctors “were not supported by the main medical evidence.” In fact, the court found out that they were “contradictory”.
Dwyer, who was pleased to find out about the agency’s investigation, said it hoped that this leads to “significant action”.
“I would never think that our story would be part of this,” she said. “I think it is incredible that the Department of Labor draws attention to this issue and investigates insurance.
