Attorney General Schneiderman Calls for Aggressive Enforcement
of Substance Abuse/ Mental Health Treatment under Timothy’s Law

We commend Attorney General Schneiderman for his tireless efforts and
support for Timothy’s Law. We are pleased to see his latest initiative that
involves an aggressive enforcement approach to insure that substance abuse
services under Timothy’s Law (Mental Health Parity) are held to the same
standard as they are for medical and surgical benefits.

May 11th 2016

A.G. Schneiderman Offers Assistance For Individuals And Families Seeking
Substance Abuse And Mental Health Treatment

New York State Residents Encouraged To Call Attorney General’s Health Care
Helpline For Assistance Obtaining Treatment

Helpline Aims To Hold Health Insurers To Legal Obligation To Provide
Necessary Medical Care

NEW YORK – Attorney General Eric T. Schneiderman today announced that his
office is offering assistance for individuals and families seeking
substance abuse and/or mental health treatment. New York’s mental health
parity law
,
known as Timothy’s Law, was enacted in 2006 and requires that insurers
provide broad based coverage for the diagnosis and treatment of mental
health disorders at least equal to coverage provided for other health
conditions. The New York Insurance Law also requires health plans to
administer substance abuse treatment coverage consistent with the federal
Mental Health Parity and Addiction Equity Act, which was enacted in 2008,
and prohibits health plans from imposing greater financial requirements or
treatment limitations on mental health or substance use disorder benefits
than on medical or surgical benefits.

In order to help protect the rights of patients, Attorney General
Schneiderman today issued an alert encouraging those seeking treatment or
facing barriers with their health insurer to call his office’s Health Care
Helpline at 1-800-428-9071.

“Under the parity laws, health insurers are required to handle claims for
mental health and addiction treatment services the same as medical claims,”
said Attorney General Schneiderman. “My office has taken an aggressive
approach to enforcing these laws and will continue to take on those who
ignore the law and, by doing so, reinforce the false and painful stigma
often associated with substance abuse and mental health conditions.”

The alert from Attorney General Schneiderman aims to assist New York
residents and their families who are struggling with substance abuse or
mental health disorders. According to the Centers for Disease Control
(CDC), the number of drug overdoses related to opioid abuses have increased
dramatically over the past decade, including over 2,000 drug overdose
deaths in New York in 2014. Today’s alert aims to assist residents with
knowing their rights when accessing substance abuse treatment through their
insurance provider, and encourages them to contact the Attorney General’s
Health Care Helpline with any questions.

New York State law mandates group health insurance plans cover inpatient
and outpatient mental health and substance use disorder treatment
(including detoxification and rehabilitation services) subject to plan
review of medical necessity. Plans must conduct medical necessity review
and calculate co-payments and co-insurance for mental health and substance
use disorder benefits in a manner consistent with medical/surgical benefits.

Over the past two years, the Attorney General’s Health Care Bureau has
signed agreements with five major companies (Cigna, MVP, EmblemHealth,
ValueOptions/Beacon, and Excellus), representing millions of members across
New York State, after determining that these companies were not in
compliance with federal and state mental health parity laws. The Attorney
General’s investigation found that the companies were improperly denying
patients who were seeking mental health and substance abuse treatment. The
settlements required the companies to implement a host of reforms to comply
with state and federal law, and gave members the opportunity to appeal
medical necessity denials. The Attorney General’s office also recovered
$2.9 million in penalties, and secured $1.6 million in consumer
reimbursements for out-of-pocket treatment costs. Since the agreements were
signed, ongoing monitoring has for most plans shown fewer barriers to
treatment, including lower denial rates and more consumers accessing needed
care.

In addition, the Helpline has addressed numerous complaints about health
plan coverage of mental health care, and has succeeded in many cases with
obtaining approval of medically necessary care, or reimbursement where the
consumer has paid for mental health care out-of-pocket.

Any resident who is denied substance abuse treatment should:

– Check the denial letter for accuracy and inform plan of mistakes.
– Ask the health provider to submit a letter of medical necessity,
including facts that show that you meet the relevant medical necessity
criteria, point-by-point.
– Request a written, detailed explanation of the denial from the health
insurance company.
– Look for common improper denial flags, such as “fail first”
requirements, reduced payments for out-of-network providers, insufficient
or incorrect information in denial letters, refusing to provide medical
necessity criteria or using criteria that do not match the health
condition, and failure to consult with the health provider or consider
medical evidence supplied.

“If your health plan denies the treatment your provider recommends,
remember, you have rights under New York State law,” said *Avi Israel,
President of the addiction recovery non-profit Save the Michaels of the
World*. “Your loved one shouldn’t have to ‘fail first’ and you have the
right to appeal the plan’s denial. Don’t simply take no for an answer and
walk away. Call Attorney General Eric Schneiderman’s Health Care Helpline
and ask for help.”

“The radical transformation of the health care system has rendered people
sometimes confused by the laws designed to improve access and quality of
care for the people it serves,” said *Jeremy Klemanski, President & CEO,
Syracuse Behavioral Healthcare*. “The Attorney General’s Helpline is a
tremendous resource to help any of us verify the correctness of how our
insurance is, or is not working to provide the care we are paying our
premiums for. The average person may not have an attorney on speed dial,
but every New Yorker has the Attorney Generals legal team on speed dial by
calling the Health Care Bureau Helpline.”

“NCADD-RA supports the NYS Attorney General’s health insurance
know-your-rights alert and supports the full implementation of NY’s parity
law (Timothy’s Law),” said *Jennifer Faringer, Director, DePaul’s National
Council on Alcoholism and Drug Dependence – Rochester Area*. “Until both
substance use disorders and mental health disorders are regarded the same,
viewed without stigma, and treated on par with coverage equal to that of
any other disease, we will have not achieved true parity in NYS. We join
the AG in encouraging individuals and their families to contact the AG
Health Care Helpline with any questions.”

“Horizon is committed to providing necessary education and resources to our
community on how best to navigate treatment services for patients and their
families struggling with substance use and mental health disorders,” said *Anne
D. Constantino, President & CEO, Horizon Health Services*. “We appreciate
the efforts of the Attorney General’s office in bringing these issues to
the attention of our community members, providing resources and assisting
those members amongst this epidemic.”

“If our society is ever to stop the proliferation of opiate drug addiction,
then it must make a commitment to treat the many addicts in dire need of
help,” said *John Socci, Board Member of HEAL of Cayuga County*. “Our
organization has seen many addicts denied treatment coverage and we believe
under the law, health insurance companies have an obligation to provide
such coverage.”

“We have an opportunity to save a life by providing treatment to those
suffering with addiction,” said *Monika Taylor, LCSW, CASAC Director at
Crouse Hospital Chemical Dependency Treatment Services*. “The helpline
assists these individuals and their families navigate through the difficult
process of getting treatment through their health insurance companies.”

“Drug Crisis in our Backyard is in full support of the Attorney General’s
initiative to bring awareness of the mental health parity act,” said *Susan
Salomone, Executive Director of Drug Crisis in our Backyard*. “Because of
the stigma associated with this disease, those suffering do not know where
to turn for help. The AG’s helpline is an important resource for people
trying to access critical information regarding insurance coverage.”

“As we continue to address this unprecedented health crisis, removing
barriers to addiction treatment is absolutely critical and for families
that often means doing battle with both a relentless disease and with their
insurance company,” said *Jeffrey L. Reynolds, President & CEO, Family and
Children’s Association.* “We are fortunate to have an Attorney General in
Eric Schneiderman who is working to remove barriers to care and continues
to be a champion for New York’s families in need.”

“The Long Island Council on Alcoholism and Drug Dependence (LICADD)
commends Attorney General Schneiderman for his continued care and concern
for New York families struggling with substance use disorders,” said *Steven
Chassman, Executive Director, The Long Island Council on Alcoholism and
Drug Dependence (LICADD). *“In order to turn the corner on this devastating
public health crisis that is taking the lives of too many New Yorkers,
access to quality and affordable treatment is essential. It has been
entirely too common and tragic that individuals are denied access to
quality treatment based on cost saving models by insurance companies. As a
result, the substance use crisis has only progressed to horrific levels of
loss and destruction for thousands of New York families. An individual’s
ability to access his/her insurance benefits and to be granted the
opportunity to receive quality treatment, should be considered a basic
right that should not be denied. LICADD offers gratitude and appreciation
to Attorney General Schneiderman on behalf of the thousands of individuals
we see each year who are denied access to quality treatment for substance
use disorders.”

“We commend Attorney General Schneiderman for his tireless efforts in
support and enforcement of Timothy’s Law (Mental Health Parity),” said Glenn
Liebman, CEO of the Mental Health Association of NYS. “There has been a
great deal of nationwide confusion about the scope of mental health parity
and the impact to families and individuals with mental health concerns. The
Attorney General and his staff have contributed to helping to create an
environment in New York that is pro-active and responsive to the needs of
those impacted by mental illness. To that end, we strongly support the
Attorney General’s initiative to provide education and public awareness to
the hundreds of thousands of New Yorkers who have a co-occurring mental
illness and substance abuse issue.”

Consumers with questions or concerns about rights for those seeking drug
abuse treatment or other health care matters may call the Attorney
General’s Health Care Bureau Helpline at 1-800-428-9071 FREE.

Glenn Liebman, CEO

Mental Health Association in New York State, Inc.

 

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