New York State Seal
STATE OF NEW YORK
INSURANCE DEPARTMENT
25 BEAVER STREET
NEW YORK, NEW YORK 10004

David A. Paterson
Governor

Eric R. Dinallo
Superintendent

OGC Op. No. 08-07-12

The Office of General Counsel issued the following opinion on July 16, 2008 representing the position of the New York State Insurance Department.

Re: Mental Health Professionals as Covered Providers

Question Presented:

May an insurer, including a health maintenance organization (HMO), refuse to accept a licensed mental health counselor as a covered provider under their policies or contracts?

Conclusion:

Yes. There is no statutory requirement that the services of such professionals be covered.

Facts:

The inquirer is licensed as a mental health counselor pursuant to N.Y. Educ. Law Article 163 , and states that he has “been turned down by insurance companies because they are stating that they do not accept this license as a provider.” He questions whether the insurers may lawfully do so.

Analysis:

New York, unlike some states, see Kentucky Association of Health Plans v. Miller, 538 U.S. 329 (2003), does not require insurers, including HMOs, to accept all qualified providers in their networks. Nor does the New York Insurance Law require insurers to cover the services of all licensed health care providers.

In 2006, the New York State Legislature enacted Timothy’s Law, see ch. 748 of the Laws of 2006, to extend required coverage to include mental health coverage. Insurance Law § 3221 establishes the minimum requirements for group health insurance policies issued by a commercial insurer. Insurance Law § 3221(l)(5)(A) requires coverage of specified out-patient mental health services provided by physicians, psychologists, and clinical social workers. Insurance Law § 4303 establishes the minimum requirements for group health insurance contracts issued by not-for-profit health insurers and all HMOs. And Insurance Law § 4303(g) & (h) requires coverage of specified out-patient mental health services provided by physicians, psychologists, and clinical social workers.

Although mental health counselors are recognized as mental health practitioners in the Education Law, they are not among the professions specified in Timothy’s Law. Accordingly, an insurer is not statutorily required to provide coverage for their services.

For further information you may contact Principal Attorney Alan Rachlin at the New York City Office.