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Tuesday, Nov 25, 2025
Outside the box.
Washington State Fines Regence Blue Shield $550 K for Mental-Health Parity Violations
Insurer penalised for failing to demonstrate parity between behavioural-health and medical-care benefits
Washington’s Office of the Insurance Commissioner has levied a penalty of US$550,000 against health insurer Regence Blue Shield for violations of both the federal Mental Health Parity and Addiction Equity Act and the State’s provider-directory regulations.
Investigators found that Regence failed to supply sufficient documentation showing that its behavioural-health benefits were comparable to its medical or surgical coverage, including differences in in-network reimbursement rates and consumer access provisions.
Commissioner Patty Kuderer stated that during the examination Regence’s staff “appeared to willfully misinterpret our questions, dismiss our concerns and generally disregard their own responsibilities to their members’ well-being.” The order requires the insurer to pay the fine into Washington’s general fund, which has collected over US$44 million in such enforcement payments since 2001.
Regence responded by asserting that it has implemented the required state and federal requirements for behavioural-health access in good faith, and has made “necessary updates” while committing to ongoing collaboration with the regulator on future rule-making.
Spokesperson Ashley Bach said, “Everyone should have access to high-quality behavioural-health care,” and confirmed the company’s intent to prioritise compliance and support consistent standard-setting.
This action follows a similar US$550,000 fine earlier this year against Premera Blue Cross for mental-health parity failings.
The regulator emphasised that state and federal law prohibit insurers from imposing any greater limits—such as higher co-payments or fewer in-network providers—on behavioural-health services than on medical care.
A state-law reform effective in 2027 will reinforce that mental-health and substance-use-disorder treatment must be treated as medically necessary care.
As insurers respond to heightened regulatory scrutiny, the Regence enforcement signals to the industry that ensuring parity claims are substantiated with clear documentation, benefit limitations are comparable across domains, and directories of behavioural-health providers meet accessibility and transparency requirements is a key regulatory priority.
Investigators found that Regence failed to supply sufficient documentation showing that its behavioural-health benefits were comparable to its medical or surgical coverage, including differences in in-network reimbursement rates and consumer access provisions.
Commissioner Patty Kuderer stated that during the examination Regence’s staff “appeared to willfully misinterpret our questions, dismiss our concerns and generally disregard their own responsibilities to their members’ well-being.” The order requires the insurer to pay the fine into Washington’s general fund, which has collected over US$44 million in such enforcement payments since 2001.
Regence responded by asserting that it has implemented the required state and federal requirements for behavioural-health access in good faith, and has made “necessary updates” while committing to ongoing collaboration with the regulator on future rule-making.
Spokesperson Ashley Bach said, “Everyone should have access to high-quality behavioural-health care,” and confirmed the company’s intent to prioritise compliance and support consistent standard-setting.
This action follows a similar US$550,000 fine earlier this year against Premera Blue Cross for mental-health parity failings.
The regulator emphasised that state and federal law prohibit insurers from imposing any greater limits—such as higher co-payments or fewer in-network providers—on behavioural-health services than on medical care.
A state-law reform effective in 2027 will reinforce that mental-health and substance-use-disorder treatment must be treated as medically necessary care.
As insurers respond to heightened regulatory scrutiny, the Regence enforcement signals to the industry that ensuring parity claims are substantiated with clear documentation, benefit limitations are comparable across domains, and directories of behavioural-health providers meet accessibility and transparency requirements is a key regulatory priority.
