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4 Oregon insurers face up to $250k fines for alleged mental healthcare violations


Four Oregon health insurers, including UnitedHealthcare and Kaiser Foundation Health Plan of the Northwest, face penalties for allegedly not complying with state parity law requiring equal coverage for mental healthcare.

Under Oregon’s mental health parity law, payers must cover mental health conditions as they would cover physical conditions. For example, Oregon insurers are barred from categorically denying coverage for mental health Applied Behavior Analysis therapy, a treatment commonly used by autism patients.

The Oregon Department of Consumer and Business Services issued proposed penalties against Minnetonka, Minn.-based UnitedHealthcare, Portland-based Kaiser Foundation Health Plan of the Northwest, Portland-based Regence BlueCross BlueShield of Oregon and Pioneer Educators Health Trust in Forest Grove.

The four payers face fines ranging from $100,000 to $250,000 for alleged violations such as excluding coverage for ABA therapy in its benefits. The ODCBS fined UnitedHealthcare a proposed $110,000 for denying 22 speech therapy claims for children with a developmental disorders like autism. Kaiser faces a proposed fine of $250,000 for allegedly providing “incorrect and misleading information in its member documents about whether it would pay for members’ attorney fees in a lawsuit.”

“Despite our clear guidance to insurance companies on mental health parity, some companies continue to engage in practices that make it difficult for consumers to access treatment,” said Laura Cali Robison, Oregon insurance commissioner and administrator of the DCBS Division of Financial Regulation. “We continue to monitor this issue across the industry and will not hesitate to take strong action if warranted.”  

State officials said they will continue to work with the insurers on the final penalties.   

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