If you’ve had a claim for mental health services declined since 2006 due to a simple blanket exclusion of coverage for treatment, and you paid out of pocket for that treatment, you may be due a refund for the services you paid for.
According to a letter sent to all insurers in the state on October 20th by the Office of the Insurance Commissioner (clarifying the recent State Supreme Court decision in the case O.S.T. v. Regence BlueShield) The Washington State Mental Health Parity Act, enacted in 2006, bars insurers from using “blanket exclusions to deny services used to treat mental health conditions, if those treatments may be medically necessary.”
The letter order all insurers in that state to immediately “administer their plans consistent with the law. Issuers may not deny claims for services that may be medically necessary based on blanket or categorical exclusions, regardless of current contract language” (emphasis added)
This means that even if you are currently with an insurer who has refused to cover say, neurodevelopmental therapies or acute PTSD due to a blanket exclusion on this coverage, they must stop doing so immediately.
It doesn’t stop there.
All insurers have been ordered to identify all mental health claims which were denied on the basis of blanket exclusion, notify those current or former policy holders of the clarification in the law, and give those policy holders the opportunity to have their requests for coverage be re-processed given the recent clarifying language from the court.
So you can be proactive and contact your insurer on your own to talk about your options, or wait for the letter that should be coming relatively soon.
There you have it, health care reform (specifically, mental health parity laws), making a difference in people’s health care and pocketbooks.
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