BCBS of Rhode Island to pay $5M after audit reveals coverage deficiencies

Blue Cross and Blue Shield of Rhode Island will pay $5 million toward a mental health fund after a state audit revealed the health insurer was not in compliance with state and federal laws, according to the Providence Journal.

The audit uncovered a lack of mental health parity, or not providing the same level of mental health coverage as physical health services, according to State Commissioner of Health Insurance Marie Ganim, PhD. Specifically, the audit found BCBS' prior authorization process for prescription drugs impeded or delayed mental healthcare.

"We found a number of patterns and practices that needed improvement," she told the Providence Journal. "It never came to the point of fining them. They settled this effort by putting money into a fund at the Rhode Island Foundation in lieu of a penalty."

Dr. Ganim said BCBS cooperated with the audit, was transparent and aimed to fix identified issues as soon as possible. The insurer will donate $1 million a year to the fund.

The Office of the State Health Commissioner is conducting similar audits of UnitedHealthcare, Neighborhood Health Plan of Rhode Island and Tufts Health Plan, according to the report.

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