The Illinois Department of Insurance is fining health insurer Celtic Insurance Co. $1.25 million for allegedly failing to cover mental health and addiction at the same levels as other medical issues.
The company also allegedly required prior authorization to get medications for ADHD, depression, drug overdose and the treatment of opioid withdrawal symptoms, among others, according to the department. The department also said Celtic violated the Network Adequacy and Transparency Act, which requires insurers to maintain an adequate network of providers. A provider network is a group of doctors and other health care workers who have contracted with an insurance company to provide care to its members. Celtic did not provide members with an up-to-date, accurate directory of its in-network health care providers, according to the department.
The findings came from a market conduct examination conducted by the Illinois Department of Insurance covering the period of 2018 to 2020. Such examinations, conducted periodically, examine an insurer’s compliance with laws and regulations meant to protect consumers.filed by consumers in Illinois and other states, alleging the insurers defrauded them by overcharging them for plans that didn’t deliver the benefits they promised.