Nevada report flags insurers for potential mental health parity gaps, setting stage for lengthy compliance reviews
A new public list, and a familiar problem
A state report in Nevada has put renewed attention on a long-running concern for patients seeking therapy, psychiatric care, or substance use treatment: whether health insurance covers mental health care on equal terms with physical health care. The Nevada Division of Insurance, which oversees the private insurance market in the state, reported that at least 16 insurance carriers likely fell short of federal mental health and addiction parity requirements in the prior year.
The findings land in a state that has consistently ranked last for overall mental health, and they arrive amid ongoing debates about provider shortages, reimbursement rates, and administrative hurdles that can delay or prevent treatment. State officials and advocates say the report adds empirical weight to what many families already experience—difficulty finding appointments, navigating approvals, and staying in-network for behavioral health services.
The report is the second annual assessment by the division. This year it also marks a shift in transparency: for the first time, the report names insurers identified as out of compliance, a change enabled by a 2025 state law that ended previous confidentiality protections.
What parity law requires—and why it is hard to measure
Since 2008, federal law has required health plans that offer mental health and substance use disorder benefits to cover them in a manner comparable to medical and surgical benefits. In addition, the Affordable Care Act includes mental health and substance abuse disorders among 10 essential health benefits that plans need to offer.
In practice, parity is not only about whether a benefit exists on paper. It also concerns how the benefit is managed. A plan may technically cover therapy or inpatient treatment, but still make it harder to obtain through processes such as prior authorization, narrower networks, or more frequent denials.
Those management practices can be difficult to evaluate because they often fall into what policy experts describe as “nonquantitative” treatment limitations—rules and administrative steps that are not as straightforward as counting visit limits or copay amounts. Kaye Pestaina, director of patient and consumer protections at the health policy research group KFF, noted that monitoring parity is challenging in areas such as prior authorization requirements and network adequacy.
Plans may argue their networks are limited because there are relatively few providers. Providers may respond that low reimbursement rates and higher claim denials make it financially difficult to contract with insurers. Pestaina also pointed to the potential for differences of opinion over how frequently a person should be able to see a therapist or receive other treatment.
What Nevada’s report found
The division’s report describes a set of concerns suggesting that some carriers placed more barriers in the path of people seeking mental health or substance use treatment than those seeking medical care. While the report is positioned as an early step in a longer enforcement process, it identifies patterns that lawmakers and advocates say can translate into real-world delays and higher out-of-pocket costs.
State Sen. Fabian Doñate, a Las Vegas Democrat who chairs the Senate Committee on Health and Wellness, characterized the findings as a “disturbing realization” of how mental health care can be treated as second-tier compared with physical care. In his view, the issues outlined in the report can starve provider networks and push families toward more expensive out-of-network options.
Doñate argued that burdensome administrative requirements—such as heavier paperwork and higher rates of preauthorization denial—can create unequal access even when coverage technically exists. He described this as creating a “second-class tier of health care” that violates the law.
Insurers named in the report
The 16 carriers flagged include 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 plans—Health Plan of Nevada, Molina Healthcare of Nevada, and SilverSummit Health Plan—have managed care contracts with the state and provide Medicaid coverage.
Although the division’s report focuses on the private insurance market it oversees, the presence of Medicaid managed care plans on the list underscores how interconnected Nevada’s coverage landscape can be. Patients may move between employer coverage, individual plans, and Medicaid depending on eligibility and life circumstances, and the availability of behavioral health care can be affected across those transitions.
From publication delays to new disclosure rules
The report was published on Dec. 31, 2025, but it was not available on the division’s website until after media inquiries. Initially, the report did not include the names of insurance carriers identified as out of compliance. Those details were uploaded on Feb. 6 after questions were raised about why insurer names were not part of the public record.
The disclosure change stems from a 2025 state law, AB207, which ended confidentiality protections that previously kept carrier names from being publicly released in this context. One insurer report was still not linked at the time the publication issues were discussed.
Assemblymember Lisa Cole, a Las Vegas Republican who brought the legislation requiring disclosure, said she believed the delay in publishing carrier information likely reflected a “misunderstanding,” given that the law was new. She also emphasized that insurers may revisit the information they submitted to confirm accuracy and determine whether an “innocent mistake” contributed to their inclusion on the list.
“At the end of the day, it’s not about finger-pointing; it’s about fixing any potential issues that might be there,” Cole said, adding that the goal is to ensure people can get their health care.
Regulators: the report starts a process, not an immediate penalty
State officials stressed that the report is the first part of a multi-year effort to assess and ensure compliance with parity laws. There are additional steps before any carrier is formally determined to be violating the law and subject to fines.
Nevada Insurance Commissioner Ned Gaines said insurers are part of the difficulty people face in accessing mental health care, but not the only driver. He pointed to Nevada’s long-standing provider shortage and a behavioral health system that has struggled for years. In his view, addressing the report findings alone will not resolve the broader access problem.
Even so, Gaines said the report provides “empirical confirmation,” documenting and validating the access challenges many consumers already experience when seeking mental health treatment.
Gaines outlined what parity would ideally look like from a consumer perspective: medical, mental health, and substance use disorder care would be equal in convenience, appointment availability, and wait times; pricing would be comparable for services of equal time and intensity; and patients would not need to go out of network for services based on discipline or provider type.
Enforcement timelines and potential penalties
Under Nevada law, inclusion on the list does not automatically trigger initial penalties. Instead, the state must conduct additional investigation through a “market conduct examination.” Officials with the division estimated those parity examinations will likely extend into 2027.
Once examinations are completed, the state can take enforcement actions such as fines, which can reach up to $50,000. Gaines said examinations are intended to identify the underlying reasons for the issues and enable “targeted solutions” aimed at preventing parity violations in the future.
For consumers, the long timeline can be frustrating, especially when access problems are immediate. But regulators argue the examinations are necessary to establish facts and determine how plan practices operate in detail.
Industry response: reviewing findings and engaging regulators
The Nevada Association of Health Plans, which represents 10 companies, said in a statement that it affirms the importance of mental health and substance use disorder care and pointed to its work on the issue in the 2025 legislative session. The association said it was not aware of the report’s findings until contacted by a reporter, and that some carriers have since set up meetings with state regulators to discuss the report.
“We are carefully reviewing their analysis and welcome the opportunity to work with regulators to better understand any concerns and address them appropriately,” the statement said.
What access barriers can look like for families
For patients, parity problems often surface not as an abstract legal concept but as repeated delays, denials, and administrative friction when trying to start or continue care. Katrina Green, a single mother in North Las Vegas, described facing access challenges for years. She estimated that about 80% of the rejections and delays she experienced in mental health treatment stemmed from insurance issues.
Green said a trained, neutral third party helping to resolve those problems could have made it easier to navigate difficult periods in her life, including challenges involving relationships and the death of one of her children.
“Had I been able to receive the help that I needed and or needed for my kids when I needed it, I probably wouldn’t hold so much resentment today and my load wouldn’t be so heavy,” Green said. “I don’t even need solutions half the time. I just need to get it out loud and say it so that it’s heard.”
Advocates: denials and narrow networks can raise risks and costs
David Lloyd, chief policy officer at the mental health organization Inseparable, said Nevada is falling short of the parity ideal described by regulators. He pointed to data from RTI International showing 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 denial of routine mental health care can have serious consequences, including higher rates of emergency department visits and hospitalizations, along with higher physical health care costs. He also warned that untreated conditions can increase overall health care costs in ways that are difficult to sustain.
In addition, Lloyd said that when mental health care is treated as secondary in coverage and payment, it can worsen provider shortages. Many providers, he noted, find that reimbursement for mental health services does not cover costs, making it hard to afford contracts with insurers.
A national issue, not just a Nevada issue
Several experts emphasized that Nevada’s parity challenges reflect a broader pattern seen across the country. Rich Collins, a Washington, D.C.-based attorney who has litigated mental health parity violations, said the problem extends to “ghost networks” of providers who appear in directories but cannot actually take patients.
Collins also pointed to a rise in insurers’ use of artificial intelligence that can drive up claim denials. He said enforcement through regulators can take a long time, and that fines can sometimes feel like a “slap on the wrist” rather than a meaningful economic incentive for insurers to change behavior.
Some states have sought to increase the financial impact of enforcement. Georgia, for example, issued nearly $25 million in fines for mental health parity violations in August, according to Collins, as a way to encourage compliance.
How private coverage and Medicaid pressures intersect
Although the Nevada Division of Insurance report focuses on private insurers, officials with the Nevada Health Authority said Nevada Medicaid has created a similar report on mental health parity in the insurance programs it oversees.
Stacie Weeks, director of the Nevada Health Authority, warned that parity issues in private insurance can shift costs and demand onto Medicaid. She said families shopping for their own coverage should not have to look for ways to become eligible for Medicaid to address serious behavioral health conditions.
Weeks emphasized the importance of provider networks in the private market being able to meet the needs of non-Medicaid, higher-income populations for behavioral health services. Otherwise, she said, the state risks a continued shift from privately paid care to taxpayer-funded Medicaid for these services.
What consumers can do if they face problems
Regulators say consumers who are struggling to obtain mental health care through their insurance can file a complaint with the Nevada Division of Insurance. Gaines said the division is working toward compliance but described the overall problem as “ubiquitous” and complex, requiring comprehensive solutions beyond regulation alone.
For many Nevadans, the report’s value may be less about immediate sanctions and more about establishing a public record: it documents patterns that patients, providers, and advocates say they have experienced for years. The next phase—market conduct examinations—will determine what enforcement actions, if any, follow, and whether targeted changes can narrow the gap between mental and physical health coverage in the state.
Key points at a glance
A Nevada Division of Insurance report found at least 16 carriers likely out of compliance with federal mental health and addiction parity requirements.
The report names carriers for the first time, following a 2025 state law ending confidentiality protections for this information.
Officials say the report begins a multi-year process; market conduct examinations may extend into 2027 before fines are considered.
Lawmakers and advocates argue administrative hurdles and network issues can push patients into delayed care or out-of-network services.
Regulators and experts say parity enforcement is difficult, especially for nonquantitative limits like prior authorization and network adequacy.