By law, insurers must cover mental and physical health equally in Georgia. But advocates say the new fines aren’t enough to make plans on paper a reality.
ATLANTA – Georgia’s landmark mental health parity law is being hailed as the “gold standard” when it passes in 2022, requiring insurers to treat mental health care the same as physical health care. But advocates say years later, enforcement—not legislation—is the real problem.
Earlier this year, Insurance Commissioner John King announced a $25 million fine against insurance companies accused of violating the law. The penalty is intended to show that companies that deny or limit mental health coverage will be held accountable.
So far, according to an 11Alive Investigates open records request, no money has been collected. By law, insurers have the right to appeal. The Fire Safety Insurance Office, while eager to announce its own fines, said it could not discuss whether the companies had taken that option or provide plans for corrective action.
11Alive Investigates filed another open records request, this time looking at historical enforcement actions. The review shows that the commissioner’s office has collected about $8 million in fines from insurance companies over the past five years — more than half of that from a case involving Blue Cross Blue Shield in 2022.
But again, we can’t find out how many fines were issued in the appeals process or resolved in any other way.
“Having a law doesn’t mean anything if you don’t have enforcement to go along with it,” said Roland Behm, head of Georgia Mental Health Policy Partners. “What we have done is a good statute, but it’s a bit toothless.”
Behm argued that the headline amount – $25 million – overstates the real impact on insurance.
“That’s $25 million for all the insurance companies combined,” he said. “When you break it down, an average individual insured will face less than $1 million.”
At that rate, he said, companies can simply treat penalties as a cost of doing business—especially if limiting treatment saves money.
“While Georgia has shown that it can punish on paper, the more difficult test is access in real life,” Behm said.
Under parity law, insurers cannot make it harder to access mental health than physical health. But violations can be subtle. They may deny coverage, delay approval, question whether a treatment is medically necessary, or maintain a network of providers with limited access.
“Delay equals denial,” Behm said, noting patients often find there are no in-network providers available even after being approved for treatment.
Although the insurance commissioner reported thousands of violations in the private market, a separate state agency did not.
The Georgia Department of Community Health, which oversees Medicaid and other taxpayer-funded coverage for foster children and low-income families, told the governor it had not identified any parity violations—despite ongoing complaints from families struggling to access care.
Behm says that the difference reflects a lack of independent oversight.
“One regulator found thousands of violations, and another found none under the same law,” he said. “That’s the problem.”
Lawmakers have considered strengthening enforcement tools.
One proposal would increase the maximum fine per violation from $5,000 to $25,000. The bill is currently in the Senate. Another measure would create an independent review panel to monitor agency-wide parity compliance. Behm hoped that this idea would gain traction, but the bill never made it out of committee.
“Usually, it doesn’t take legislation to solve it,” Behm said. “The legislation is there. It’s not being enforced.”
The advocacy group Georgians for a Healthy Future is working to create a new dashboard to track compliance and make it easier for citizens to report suspected violations.
Until then, consumers who believe they have been denied equal access to mental health care can file a complaint with the insurance commissioner’s office or the Department of Community Health.
Still, advocates warn that without consistent inspections and stronger enforcement, the promise of the law may remain out of reach.
“Imagine setting a speed limit without anyone enforcing it,” Behm said. “You’ll see what we see now, just keep zooming in.”
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