State to probe whether insurance companies are covering substance abuse issues, as required

Last modified: 11/25/2015 10:02:03 PM
New Hampshire’s Insurance Department is examining whether insurance companies are covering substance abuse services in the same way that they cover physical health services, as required by law.

The probe comes as New Hampshire seeks to expand treatment and recovery services amid a heroin and opioid crisis that has claimed more than 500 lives in two years.

The Affordable Care Act requires insurance companies to provide the same coverage for addiction treatment as they do for physical health, a concept known as parity.

Under both New Hampshire law and the federal Mental Health Parity law, insurance companies have been required for some time to treat claims for mental health and physical health services on par with each other, and New Hampshire small group market plans were required to cover such services. However, it was only starting this year that individual policies were required to cover mental health and substance use disorder services as part of the Essential Health Benefits.

Some providers and advocates say companies are denying coverage for routine treatment.

The investigation will look at coverage from Jan. 1 to Sept. 30, 2015, and the insurance department hopes to release a preliminary report by this coming January. The department has the power to order companies violating the law to correct their actions, pay penalties or leave the state.

The Affordable Care Act increases access to coverage by requiring most health plans to cover 10 essential health benefit categories, to include hospitalization, prescription drugs, maternity and newborn care, and mental health and substance use disorder services.

The health care law expands mental health and substance use disorder benefits and federal parity protections for 62 million Americans nationwide, including 253,680 New Hampshire residents.

For information or to file an appeal, contact the New Hampshire Insurance Department at 1-800-852-3416 or 271-1406, or by email at consumerservices@ins.nh.gov or at nh.gov/insurance.


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