DOVER, Del. — The Delaware Department of Insurance has fined UnitedHealthcare Insurance Company $450,000 following a comprehensive re-examination of its compliance with the Mental Health Parity and Addiction Equity Act. The investigation uncovered repeated violations related to mental and behavioral health coverage, prescription access, and claims handling.
The review also examined complaints, policyholder services, utilization review, pharmacy oversight, and third-party administrator practices. According to the department, the findings revealed longstanding issues, some of which were previously flagged in earlier examinations.
“This comprehensive re-examination of multiple areas of UnitedHealthcare’s treatment of policyholders seeking mental or behavioral health care and prescriptions will result in much needed corrections in insurer activity. We must remain vigilant in ensuring compliance with our consumer-friendly laws,” said Insurance Commissioner Trinidad Navarro. “Protecting consumers and promoting equity in health care access remains a top priority for our team, even considering the federal government’s decision not to conduct compliance on Mental Health Parity. My office has been, and will remain, the primary compliance entity for commercial carriers operating here.”
Key Findings:
Coverage Disparities: Unequal treatment between mental health and medical benefits.
Prescription Issues: Improper application of step-therapy exceptions, misapplied drug definitions, and unauthorized prior authorization requirements for medication-assisted treatment.
Drug Processing Gaps: Automated systems excluded mental health medications, while the company also applied an unauthorized definition of “specialty drug.”
Treatment Standards: Failure to fully apply American Society of Addiction Medicine (ASAM) criteria, limiting coverage for substance use disorder treatment.
Reporting Failures: Insufficient detail in federally required parity analyses, making it unclear whether mental health benefits were applied as fairly as medical benefits.
The examination covered a 24-month period, and because some violations had been cited in previous reviews, the penalty was increased.
Since Delaware began enforcing mental health parity compliance, insurers have been assessed a total of $2.11 million in penalties, with all funds directed to the state’s General Fund.