Commissioner King to Fine Insurers over $20 Million for Mental Health Parity Violations

ATLANTA – Insurance and Safety Fire Commissioner John F. King announced today that he will fine health insurance companies over $20 million dollars for violating Mental Health Parity laws.

“I was there when Georgia’s Mental Health Parity Act was signed into law in 2022. Three years later, our initial examinations show that insurers have turned a blind eye to the rules and continue to deprive Georgians of the essential behavioral health resources they deserve,” said Commissioner King.

The Mental Health Parity Act of Georgia, in coordination with the federal Mental Health Parity and Addiction Equity Act of 2008, requires that insurers provide coverage for Mental Health and Substance Use Disorders in a manner comparable to that of physical health coverage. The Georgia Insurance Commissioner is tasked to oversee private insurer compliance with the law, including an annual in-depth review of insurer data, processes and strategies for benefit applications, and non-quantitative treatment limitations (NQTLs). 

Our office is required to conduct a data call no later than May 15 of every year to evaluate insurer compliance with parity laws, with the subsequent report to be published on August 15. If the information collected suggests a potential parity violation, the OCI is required to initiate market conduct examinations to determine whether the mental health parity requirements are being satisfied.

In compliance with Georgia law, the first mental health parity data call report was produced on August 15, 2023. Findings from the report triggered the OCI to conduct market conduct examinations against twenty-two insurers. Market conduct examinations are comprehensive, data intensive audits of an insurer’s business practices and often take several months or years to conduct based on the size of the company, complexity of the examination, and need for accurate results that stand up under legal scrutiny.

Results from initial examinations have uncovered over 6,000 parity violations. Common violations include: 

• Inconsistent identification and application of benefit classifications
• Application of prior authorization for services not identified as requiring such authorization
• Concurrent review authorization is applied for services not identified as requiring such authorization
• Claims being reprocessed due to post service review for medical necessity when the triggering event for such review is unclear

Pursuant to the Official Code of Georgia Annotated § 33-1-27(i), the Commissioner, “may impose a monetary penalty of up to $2,000.00 for each and every act in violation, unless the insurer knew or reasonably should have known that he or she was in violation, in which case the monetary penalty may be increased to an amount of up to $5,000.00 for each and every act in violation.” Insurers that fail to comply with parity laws may be placed under a compliance plan, be ordered to develop a compliance plan, or be ordered to reprocess claims. 

“The time to get in compliance with the law was yesterday,” Commissioner King remarked about the fines. “Today, we are taking decisive action to hold those who think they can skirt the law accountable. I will not tolerate games, excuses, or stalling tactics from these companies, and we will come after those who try with every tool at our disposal.”

The OCI will continue to monitor and ensure compliance with mental health parity laws through corrective action and enforcement tools available under Georgia law. Consumers who believe they are the victim of a mental health parity violation may file a complaint on our website, or call us toll-free at 1-800-656-2298.

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The mission of the Office of Commissioner of Insurance and Safety Fire is to protect Georgia families by providing access to vital insurance products and safe buildings through fair regulation that creates economic opportunities for all Georgians.