SB244 needs work

I am writing to express my strong opposition to Senate Bill 244 in its current form. 

While I support increased access to behavioral health screenings, this bill, as written, fails to ensure meaningful mental health care and leaves dangerous loopholes that insurance companies can exploit to deny coverage, increase patient costs, and avoid accountability. 

Health insurance companies in the U.S., including those operating in Montana, have a long history of denying coverage for necessary healthcare services, often with little accountability. This has been particularly problematic in the area of behavioral health, where insurers frequently refuse to cover mental health screenings, therapy, or psychiatric care, citing reasons such as:

• Medical necessity determinations – Claiming the service is not “medically necessary” even when recommended by a doctor.

• Coverage limitations – Restricting access by requiring excessive prior authorizations or limiting the number of covered visits.

• Provider network restrictions – Many insurers limit the availability of in-network mental health providers, making it difficult for patients to find care.

• Arbitrary denials – Even when a service is supposed to be covered, insurers may deny claims outright, forcing patients to go through lengthy appeal processes.

Despite federal and state parity laws, which require insurance companies to treat mental health coverage the same as physical health coverage, insurers still find ways to avoid paying for behavioral health services through loopholes and weak enforcement mechanisms.

Without stronger provisions, SB 244 risks being a hollow mandate that does not improve access to behavioral health care.

Key Concerns with SB 244

1. Lack of Guaranteed Coverage for Follow-Up Care

   • SB 244 requires insurers to cover behavioral health screenings, but it does not mandate coverage for necessary follow-up services like therapy, psychiatric evaluations, or treatment.

   • Screenings alone are not sufficient—patients must have access to care if a screening identifies a mental health condition. Without this, individuals may receive a diagnosis but be unable to access the care they need.

2. Potential for Insurers to Shift Costs to Patients

   • The bill does not prevent insurance companies from raising premiums, deductibles, or out-of-pocket costs to offset the cost of screenings. This could make mental health care even less accessible.

   • Insurance companies have a history of finding ways to avoid true mental health parity, and this bill does nothing to stop them from passing costs onto consumers.

3. No Protections Against Arbitrary Denials of Coverage

   • Insurers can still deny necessary behavioral health services by exploiting vague "medical necessity" standards or creating burdensome pre-authorization requirements.

   • The bill should require transparency in coverage denials, establish clear medical necessity standards, and impose penalties for wrongful denials.

   • Narrow definitions of "screening" – Insurers might limit the types of standardized, evidence-based screenings they cover, making it difficult for providers to choose the best tools.

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4. Failure to Address Provider Access Issues

   • Many Montanans, especially in rural areas, struggle to access behavioral health providers due to insufficient provider networks.

   • Without a requirement that insurers cover out-of-network care at in-network rates when no in-network provider is available, patients may still be unable to get screened or treated.

5. Weak Enforcement Mechanisms

   • The bill lacks consequences for noncompliance. Insurers must be held accountable through fines, mandatory reporting, and stronger oversight to ensure they truly cover screenings and follow-up care.

6. Insurance companies operate with significant discretion and minimal accountability, particularly in the private sector. Key reasons for this include:

7. Weak enforcement mechanisms – State insurance commissioners and federal agencies often lack the resources or political will to challenge insurers effectively.

8. Legal loopholes – Insurers use fine print, contractual terms, and technicalities to deny coverage legally.

9. Complex appeal processes – Many patients do not have the resources to fight insurance denials, and even when they do, the appeal process can take months or years.

10. Influence of the insurance lobby – The health insurance industry exerts powerful influence over lawmakers, often shaping legislation in ways that favor profits over patient care.

How SB 244 Can Be Improved

To truly improve behavioral health access in Montana, SB 244 must include:

• Guaranteed coverage for follow-up care after a positive screening.

• Protections against insurers shifting costs to patients through higher premiums or cost-sharing.

• Strict limitations on arbitrary denials and transparency in medical necessity decisions.

• Remove Insurances companies ability to deny coverage when the patient's physician/counselor/clinician recommends care and treatment. 

• Stronger provider network requirements, including coverage for out-of-network providers at in-network rates when necessary.

• Enforceable penalties for insurance companies that fail to comply.

• Strict definitions of required screenings to prevent insurers from limiting options.

• Transparent reporting requirements for insurers to show compliance.

• Penalties for noncompliance to ensure insurers cannot ignore the law without consequences.

• Provisions for follow-up care so patients are not left with an uncovered diagnosis.

• Telehealth services be covered without restrictions for behavioral health.

• Insurers expand their provider networks to meet demand.

As written, SB 244 does not ensure meaningful access to mental health care and allows insurance companies to continue avoiding accountability.

I urge you to oppose this bill in its current state and instead advocate for a stronger, more comprehensive approach that truly expands behavioral health access without loopholes or increased costs for Montanans.

Thank you for your time and consideration.

I look forward to your response and hope to see a revised bill that prioritizes true mental health access over superficial insurance mandates.