OHIC Investigates Coverage Of Mental Health & Addiction Treatment

Dec 1, 2015

Rhode Island’s Health Insurance Commissioner has received some patient complaints that insurers failed to cover the mental illness or addiction treatment  they needed. 

RI health officials will test health insurers' plans to ensure they adequately cover mental illness and addiction treatment.
Credit Aaron Read / RIPR

That's why the office will now undertake a system-wide test of health insurers' plans and practices under the federal Mental Health Parity and Addiction Equity Act. It prohibits coverage limits for mental health and substance abuse treatment that aren't imposed for medical or surgical coverage.

When you need physical rehab after knee surgery, your health insurance usually covers it. When you need 30 days of rehab for addiction, is that covered too? Not necessarily, according to investigators with Rhode Island’s Office of the Health Insurance Commissioner, or OHIC.

The office has received some patient complaints about coverage for substance abuse and mental health treatment. They suggest insurers might not be following the law to the letter. It says insurers have to cover mental health care on par with how they cover other kinds of medical care.

Now, an OHIC team will conduct a comprehensive examination of insurers to ensure compliance with the law. An OHIC spokeswoman says the goal is to make sure patients don’t face unnecessary obstacles to getting the care they need. 

OHIC has sent notices to all health insurers doing business in the state, alerting them that they must provide any documents, witnesses, data, or other materials OHIC requests to conduct its exam.

The end result of the investigation could be a clearer picture of the extent to which treatment for mental illness and addiction are accessible and affordable.