In February, Joan Goldstein of Monroe received a panicked call for help from her wife, Lauren Goldstein. Joan found Lauren rolled up like a ball on the floor in her office bathroom. “I have never seen her sick in 15 years,” Joan said. When Lauren couldn’t stop vomiting, Joan took her to the emergency room at St. Vincent’s Medical Center in Bridgeport, where she received fluids intravenously—“three bags,” Joan said.
The rate of denials by the state’s largest managed care insurers of requests for mental health services rose nearly 70 percent between 2013 and 2014, with an average of about one in 12 requests for prescribed treatment initially rejected, a new state report shows. At the same time, the proportion of enrollees in the largest managed care companies who received outpatient or emergency department care for mental health doubled, from an average of 9.4 percent in 2013 to 20.8 percent in 2014, according to an analysis of the 2015 Consumer Report Card on Health Insurance Carriers in Connecticut, issued by the state Insurance Department. The percentage of members who received inpatient mental health care also doubled, although it remained low, with most companies providing inpatient services for less than .5 percent of all enrollees. The rise in rejections by the state’s 10 largest indemnity managed care companies – private health insurers, not including Medicare or Medicaid — came as state officials focused on improving mental health outreach and treatment, in the wake of the Sandy Hook school shooting in December 2012. The managed care organizations include companies such as Aetna Life Insurance Co., Anthem Health Plans, CIGNA Health and Life Insurance Co., and UnitedHealthcare Insurance Co.
For the first time, all Connecticut health insurance companies will be required to cover infertility treatment for people age 40 and older. The state’s Insurance Department said that failure to provide the coverage constitutes age discrimination in violation of the federal Affordable Care Act (ACA). The new requirement takes effect Jan. 1. “Limits to coverage that are discriminatory run counter to the clear intent of the Affordable Care Act and we must ensure that our state laws and guidelines are compliant,” said state Insurance Commissioner Katharine L. Wade.
Women in Connecticut have been denied health insurance benefits in violation of the federal Affordable Care Act, according to a study by the National Women’s Law Center. Connecticut is one of 15 states included in the study, which analyzed the 2014 and 2015 health plans of companies that provide coverage under the ACA in state marketplaces. It found violations in all 15 states and concluded that they are likely occurring nationwide. According to the report, Connecticut women have been denied coverage for the following: breastfeeding counseling and education after two months following delivery, infertility treatments after the age of 40, sterilization procedures, emergency birth control, and maintenance care for such things as lupus, HIV, and hormones after breast cancer treatment. Coverage was also denied for transgender transitions.
Consumers with health and accident insurance complaints were among the top beneficiaries of the $8.7 million recovered by the Connecticut Insurance Department for policyholders and state taxpayers in 2012, the state agency announced Thursday. More than half of the $4.1 million recovered for policyholders by the Department’s Consumer Affairs Unit – a total of $2.1 million – stemmed from consumer complaints over health and accident insurance with unfair claims practices leading the list of offenses by insurance carriers. The Department’s Market Conduct division levied more than $4.6 million in fines against carriers with the money going back to the state General Fund. The fines resulted from various violations and settlements from untimely claim payments to improper licensing. The state’s Consumer Affairs Unit fielded more than 6,100 complaints and inquiries in 2012, including 2,143 from residents with questions about health and accident insurance.
For consumers, the new year brings changes in the Affordable Care Act ranging from limits on itemized deductions and flexible spending accounts to Medicare-related tax increases and standardized forms that describe benefits in plain English. In many ways, Connecticut leads the nation in implementing reform from establishing an online marketplace to purchase health insurance and expanding Medicaid coverage to low-income adults to generating millions of dollars in savings for consumers with coverage issues. Changes coming in 2013 and 2014 include:
Limits On Itemized Tax Deductions: The rules for itemizing deductions on federal income tax returns have changed. Beginning 2013, taxpayers can claim deductions for medical expenses not covered by health insurance when they reach 10 percent of adjusted gross income, up from 7.5 percent. The law waives the increase for those 65 years and older for tax years 2013 through 2016.