Nevada report flags 16 insurers for likely mental health parity gaps, launching a long compliance review
A report that names names—and starts a longer process
A new state report in Nevada has put a spotlight on how some insurance plans may be treating mental health and substance use disorder care differently from physical health care. The Nevada Division of Insurance, which oversees the private insurance market, found that at least 16 insurance carriers likely fell short of federal mental health and addiction parity requirements last year.
The report is described by state officials as the first stage of a longer, yearslong effort to assess compliance and, where needed, push insurers toward corrective action. Importantly, the report does not itself represent the final word on whether any carrier violated the law. Regulators say there are additional steps before a plan can be formally determined to be in violation and fined.
Still, the findings have drawn strong reactions from lawmakers and advocates who say unequal access to behavioral health treatment can leave families navigating delays, paperwork, and denials that are not comparable to what they face for medical or surgical care.
What parity law requires—and why it matters in Nevada
Since 2008, federal law has required health plans that cover mental health and substance use disorder services to cover them in a way that is comparable to coverage for medical care. The Affordable Care Act also identifies mental health and substance abuse disorders as one of 10 essential health benefits that plans must offer.
Parity is not only about whether a benefit exists on paper. It also concerns how easy it is to actually use that benefit. That can include issues such as prior authorization requirements, claim denials, and whether people can find in-network providers without long waits or having to go out of network.
Those questions are especially consequential in Nevada, which has consistently ranked last for overall mental health. State leaders and consumer advocates argue that when access is constrained by insurance rules and administrative barriers, the consequences can ripple through families and communities—particularly in a state already grappling with a long-standing behavioral health provider shortage.
Key finding: at least 16 carriers likely out of compliance
The Division of Insurance’s second annual report concludes that at least 16 carriers were likely out of compliance with parity requirements. The report, for the first time, identifies the insurers flagged as noncompliant, a shift that follows a change in state law.
Among the carriers listed are United Healthcare Insurance Co., Aetna Health Inc., SilverSummit Health Plan, Health Plan of Nevada Inc., and Sierra Health and Life Ins Co. The report also notes that three of the plans—Health Plan of Nevada, Molina Healthcare of Nevada, and SilverSummit Health Plan—have managed care contracts with the state and provide Medicaid coverage.
While the report identifies likely parity problems, state officials emphasize that enforcement is not immediate. Nevada law requires additional investigation through what is known as a “market conduct examination,” a deeper review intended to determine the underlying reasons for the issues and to guide targeted solutions.
Lawmakers: unequal treatment can create a “second-class” tier of care
State Sen. Fabian Doñate (D-Las Vegas), who chairs the Senate Committee on Health and Wellness, said the report’s findings were a “disturbing realization” of how the state’s insurance market can fail to provide fair access to mental health care.
In his view, the report describes a system that can starve provider networks and push families into more expensive out-of-network care. Doñate argued that when mental health patients face substantially more paperwork and higher rates of prior-authorization denials than medical patients, the result is a second-tier form of health care that conflicts with what parity law requires.
Another lawmaker, Assm. Lisa Cole (R-Las Vegas), played a key role in requiring public disclosure of carriers identified in these reports. Cole said she believed a delay in publishing the carrier information likely stemmed from a misunderstanding because the disclosure requirement is new. She also stressed that the goal is not finger-pointing but fixing potential issues so people can get needed care.
Why the report became public later—and what changed in state law
The report was published on Dec. 31, 2025, but it was not available on the Division of Insurance website until after media inquiries. Initially, the version that circulated did not include the names of insurers identified as out of compliance.
The carrier details were uploaded to the division’s website on Feb. 6, after questions were raised about why the names were not part of the public record. A state law enacted in 2025, AB207, ended previous confidentiality protections and allowed the names of carriers to be disclosed. The report materials indicate that one insurer report still was not linked.
Insurers’ trade group: reviewing the analysis, seeking discussions
The Nevada Association of Health Plans, which represents 10 companies, said it supports the importance of mental health and substance use disorder care and pointed to work on the issue during the 2025 session. The group said it was not aware of the report findings until contacted for comment, and noted that some carriers have set up meetings with state regulators to discuss the report.
In its statement, the association said it is carefully reviewing the analysis and welcomed the opportunity to work with regulators to better understand concerns and address them appropriately.
What consumers describe: delays, denials, and the burden of navigating care
For many families, the parity debate is not abstract. Katrina Green, a single mother in North Las Vegas, described years of access challenges and said she experienced frequent rejections and delays in mental health treatment. She estimated that about 80% of her difficulties stemmed from insurance-related issues.
Green said having a trained, neutral third party to help resolve disputes and navigate the system could have eased the strain during deeply difficult moments, including the death of one of her children. She described the emotional weight of not being able to get help when it was needed and said that sometimes what people need is simply to be heard.
Regulators: the findings validate access problems, but insurance is not the only driver
Nevada Insurance Commissioner Ned Gaines said the report offers “empirical confirmation,” documenting and validating the access challenges many consumers say they experience when seeking mental health treatment.
At the same time, Gaines emphasized that insurers are not the sole driver of access problems. Nevada’s behavioral health system faces a long-standing provider shortage, and that broader context makes it harder for people to get care. In his view, addressing the report’s findings alone will not resolve the issue.
Gaines also outlined what parity should look like in practice: mental health, medical, and substance use disorder care should be equal in convenience, appointment availability, and wait times. Pricing should be comparable for services of similar time and intensity, and consumers should not be forced out of network based on the type of care or provider they need.
Advocates: the state is still far from parity in real-world access
David Lloyd, chief policy officer at the mental health organization Inseparable, said Nevada is missing that standard. He pointed to data from RTI International indicating that Nevada patients in 2021 had to go out of network 20 times more often for acute inpatient behavioral health services than for inpatient physical health services.
Lloyd argued that denials of routine mental health care can have severe consequences, potentially increasing emergency department visits and hospitalizations and raising physical health care costs. He warned that untreated behavioral health needs can drive up overall health care costs in ways he described as unsustainable.
He also connected parity problems to provider shortages. According to Lloyd, many providers find that reimbursement for mental health services does not cover costs, making it difficult to contract with insurers.
Why parity oversight is difficult: rules beyond simple numbers
Monitoring compliance with parity law is challenging, in part because many of the most important barriers are “nonquantitative.” Kaye Pestaina, director of patient and consumer protections at KFF, noted that issues such as prior authorization and network adequacy can be hard to measure and compare.
Pestaina described a dynamic that regulators frequently encounter: plans may argue their networks are limited because there are relatively few providers, while providers may point to low reimbursement and higher claim denials as reasons they do not participate in networks. She added that there can also be differences of opinion about how often someone should be able to see a therapist or receive a particular treatment.
A national problem, with debates over enforcement and deterrence
Nevada’s gap between physical and behavioral health coverage is not unique. Rich Collins, a Washington, D.C.-based attorney who has litigated mental health parity violations, said similar problems exist across the country. He cited issues including “ghost networks,” where listed providers may not actually be available to take patients, and a rise in insurers’ use of artificial intelligence that can increase claim denials.
Collins also said enforcement can take a long time and that fines can feel like a “slap on the wrist” rather than a meaningful economic motivator for compliance. Some states, he noted, are attempting to make penalties more consequential. Georgia’s insurance commissioner, for example, issued nearly $25 million in fines for mental health parity violations in August as a way to encourage compliance.
What happens next in Nevada: examinations, timelines, and potential fines
In Nevada, even when a carrier is flagged in the report, state law does not prescribe initial penalties at that stage. Instead, the next step is a market conduct examination. Division officials estimated those parity examinations will likely extend into 2027.
Only after those examinations are completed can the state take enforcement actions, including fines. The maximum fine described in the report coverage is $50,000. Gaines said the examinations are designed to identify underlying reasons for the issues and allow the division to implement targeted solutions aimed at preventing future parity problems.
How to respond if you are struggling to access mental health care
Regulators say consumers who are having difficulty getting mental health care through their insurance can file a complaint with the Nevada Division of Insurance. Gaines said the division is working to achieve compliance, while also emphasizing that the problem is complex and requires comprehensive solutions beyond regulation alone.
Medicaid and private coverage: interconnected pressures
Although the Division of Insurance report focuses on private insurers under its oversight, officials with the Nevada Health Authority said Nevada Medicaid has created a similar report on mental health parity in the insurance programs it oversees.
State leaders also described the way parity problems can spill across the broader system. Stacie Weeks, director of the Nevada Health Authority, said families shopping for their own coverage should not have to look for ways to become eligible for Medicaid to address significant behavioral health conditions.
Weeks said it is critical that provider networks in the private market meet the needs of non-Medicaid, higher-income populations for behavioral health care. Otherwise, she warned, the state risks a continued shift from privately paid care to taxpayer-funded Medicaid for these services.
What the report signals for the insurance market
The report’s central message is both narrow and significant: multiple carriers were flagged for likely parity shortcomings, and the state is beginning a detailed review process that could lead to corrective action and, potentially, penalties.
For consumers, the practical stakes are access—whether it is possible to find an in-network therapist, get timely appointments, and receive authorization for treatment without facing extra hurdles compared with physical health care. For policymakers and regulators, the report adds documentation to longstanding complaints and sets up a multi-year effort to determine what changes are needed to bring coverage closer to the parity standard that federal law has required for more than a decade.
- The Nevada Division of Insurance report flags at least 16 carriers for likely parity noncompliance.
- The findings begin a longer process; market conduct examinations are expected to extend into 2027.
- Lawmakers and advocates argue that unequal paperwork, authorization, and network barriers can push patients out of network and delay care.
- Regulators say the report validates consumer experiences but note provider shortages also constrain access.
- Consumers can file complaints with the Division of Insurance if they face barriers to mental health coverage.