Rhode Island Insurance Commissioner Finds Blue Cross & Blue Shield Parity Non-Compliant

On September 17, 2018, the Rhode Island Office of the Health Insurance Commissioner (OHIC) said its market conduct examination of Blue Cross and Blue Shield of Rhode Island (BCBSRI) found that the health insurer failed to comply with behavioral health parity requirements. The OHIC found that BCBSRI’s utilization review processes were clinically inappropriate, and that different utilization review staff “reached very different conclusions based on similar facts and clinical circumstances.” BCBSRI documentation of utilization review criteria was “inadequate”; and that utilization review procedures were “unreasonable and inequitable” and “did not properly consider patients’ welfare and safety.” BCBSRI’s practices . . .