Greg interviews Lisa Landau, the Bureau Chief of Health Care at the NYS Office of Attorney General Eric Schneiderman. Lisa and her team have been working since 2012 to remove health care coverage blocks for those seeking treatment for substance abuse disorder.
Greg asks Lisa about why the denial rates for treatment are so high and how her team has worked to overcome this trend. Lisa explains that when she and her team looked both broadly and specifically at a multitude of health plans they found a similar tendency. “Many, many of the [health plan] denials were boilerplates. So [health care providers] were really speaking to us in a way that kind of showcased that these were not really thoughtfully prepared documents that were going to match the person’s symptoms with the specific criteria – which is what the plans are required to do.” To combat this, Lisa states that her team went both broad and detailed in their new requirements for health plans. “We required in a number of our agreements that the plan has to ensure that they are not issuing boilerplate letters. They have to provide rationale to the member to explain why this particular person wasn’t meeting the criteria.”
Listen to the podcast to discover how Lisa’s team is continuing to make healthcare providers aware of these issues and how states can address similar issues on their own.