Excellus Wrongly Denied Coverage for Addiction, Eating Disorders, New York AG Says

By Paul Gaita 04/17/15

Excellus neither confirmed nor denied Attorney General Eric T. Schneiderman's findings.

Eric T. Schneiderman
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A probe launched by the New York State Attorney General’s office has revealed that Excellus BlueCross BlueShield wrongfully denied inpatient treatment to more than 3,000 members with drug addiction or eating disorder issues between 2011 and 2014.

State Attorney General Eric T. Schneiderman announced last month that his office reached a settlement with the Rochester, NY-based nonprofit health organization that will require it to cover these services and allow members who were denied inpatient service to file appeals.

Excellus neither admitted nor denied the probe’s findings, but has agreed to cover residential treatment and reformat its claims process for mental health coverage. In a statement to the media, the company stated that it has made “a number of behavioral health benefit and policy changes prompted by revisions in the law and regulations as implemented by the New York Department of Financial Services.”

The Attorney General office’s probe showed that Excellus denied inpatient substance abuse requests because their policy required that patients fail outpatient treatment on multiple occasions, a requirement that did not extend to the company’s medical benefits and a violation of the state’s 2006 mental health parity law, known as Timothy’s Law, which requires health plans to provide equal coverage for medical and health care.

Previous investigations by Schneiderman’s office have uncovered similar violations with four other insurance providers, including Cigna, MVP Health Care, EmblemHealth, and Value Options, a behavioral health vendor for both MVP and Emblem.

“Mental health and addiction recovery treatments must be regarded the same as other health insurance claims,” said Schneiderman in a statement. “We will continue to take on those who ignore the law and reinforce the false and painful stigma often associated with these ailments.”

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, Amazon.com and The Los Angeles Beat, among many other publications and websites.