Insurers sue to delay coverage

December 30, 1993|By Frank Langfitt and John W. Frece | Frank Langfitt and John W. Frece,Staff Writers

Insurers and health maintenance organizations filed suit yesterday to stop a new state law that requires greater insurance coverage for the mentally ill.

In a hearing scheduled for 9 a.m. today in Baltimore Circuit Court, the plaintiffs plan to ask Judge Thomas Ward to either strike down the law or delay its Jan. 1 implementation.

The plaintiffs, which include Blue Cross and Blue Shield of Maryland, say the law is impossible to administer because it is incomprehensible. They argue that the state should at least issue regulations clarifying the law's meaning.

Advocates for the mentally ill acknowledge problems with the way the law was drafted but say they have been trying to work them out recently with insurers.

Now, advocates say, the insurers appear to be grasping at anything they can to get out of providing additional coverage.

"The only bargaining chip we had with the insurers . . . was that the bill goes into effect Jan. 1," said Linda Raines, executive director of the Mental Health Association of Maryland.

The so-called "parity" law requires insurers to provide benefits for the mentally ill that are comparable to those offered for other illnesses. Currently, insurance companies generally pay for a much smaller percentage of mental illness costs than for other physical ailments. Mental health advocates have complained of discrimination.

"Our position is that we want mental illness -- essentially a brain disease -- to be treated the same as any other illness," Ms. Raines said.

While the law as passed by the legislature contained some disappointments to mental health organizations -- it applies to only certain types of insurance, and it likely will mean much higher premiums for those opting for full mental health coverage -- it was still seen as a major victory in the effort to win equity for the mentally ill.

Insurers, however, say the law is vaguely worded and does not define what constitutes comparable benefits.

"Absent regulation, the act is so imprecise as to be incapable of interpretation, administration or enforcement," the suit says.

State Insurance Commissioner Dwight W. Bartlett said last night that a legislative oversight committee earlier this month disapproved emergency regulations to implement the law.

But he said: "Our position is that even in the absence of regulations, the insurers have no legitimate reason for not following the requirements of the law."

He said insurers had hoped that the governor would veto the bill.

When he did not, he said, "They hoped some solution would come out of nowhere until it really became too late for them to properly develop plans to implement the law. So, that's why they are now seeking an injunction."

Dr. Casey Ann Hughes, an Annapolis psychologist and lobbyist for the Maryland Psychological Association, said, however, that a delay might be useful.

"If there is a delay in implementation, it may give us time to work out a compromise that makes sense," she said.

The insurers hired Shapiro and Olander, the well-known Baltimore law firm, to file their suit against the state.

They include Blue Cross and Blue Shield of the National Capital Area, Connecticut General Life Insurance Co., the Illinois-based Golden Rule Insurance Co., Optimum Choice Inc. of Rockville, Cigna Healthcare Mid-Atlantic Inc. of Columbia and Health Care Corp. of the Potomac.

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