Harvard Pilgrim Will Get A Closer Look After State Study On Addiction Treatment Claims

The New Hampshire Insurance Department released the findings of a study Thursday that takes a look at how insurance companies are handling drug and alcohol abuse treatment claims.

iStock photo

iStock photo

The study, which examines the insurers Cigna, Anthem, and Harvard Pilgrim, was intended, in part, to determine if they were complying with federal parity law. In other words, do the companies provide comparable coverage for mental health, substance use disorders, and medical and surgical care?

Though Cigna and Anthem didn’t turn up too many red flags, the Insurance Department will be taking a closer look at Harvard Pilgrim. Harvard outsources claims and prior approvals to a company called United Behavioral Health – but only behavioral health claims.

Jenni Patterson is a lawyer with the New Hampshire Insurance Department.

"It looked like there was a uniform requirement of prior authorization associated with all of the services that UBH was involved with," Patterson says, "And so, if they didn’t have a similar requirement for medical/surgical, that could be a parity violation. The problem is, it’s very complicated."

Patterson says the outsourcing alone is not cause for concern. But they’re planning a second study to look at Harvard’s partnership with UBH, to determine whether the delegation of certain services is resulting in parity violation.