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Mental Health Parity

What is mental health parity? Take action

Due to changes in laws governing health insurance plans as a result of the Affordable Care Act (ACA), most commercial insurance plans must now

  • offer mental health coverage, and
  • provide benefits equal to what the plan offers for other medical conditions

In practical terms this means that the financial requirements of the plan such as deductibles, co-pays and co-insurance cannot be more restrictive than for other benefits. For example, your plan cannot charge a higher co-pay or higher co-insurance percentage to see an in-network psychiatrist than it does to see any other in-network specialist.

The plan can’t have two separate deductibles—one for physical conditions and another for mental health conditions.

The ACA also addresses treatment limitations, or limits on the frequency of treatment, the number of visits, days of coverage or duration of treatment if it does not have these same restrictions in place for other medical conditions.

The plan can’t place geographic restrictions on where you receive treatment if it does not have the same restrictions for other medical conditions.

If a plan is required to follow parity rules, you can expect equal coverage when it comes to the treatment limits and payment amounts for

  • Inpatient in-network and out-of-network
  • Partial hospitalization
  • Prescription drugs
  • Deductibles
  • Facility type
  • Outpatient in-network and out-of-network
  • Residential treatment
  • Co-pays
  • Maximum out-of-pocket limits
  • Provider reimbursement rates
  • ntensive outpatient services
  • Emergency care
  • Co-insurance
  • Geographic locations

Is Your Insurance Carrier Complying With Parity Laws? Take action

What are your rights if you believe you have been wrongfully denied coverage? Learn about mental health parity.

If you believe your insurance carrier is not complying with mental health parity laws you have the right to take action.

  • Your insurance carrier must provide you information on how they made their decision to deny you coverage
  • Once obtained, you have the right to appeal that decision

Do you know how to appeal a mental health insurance claim denial?

Stigma is erased by standing up for your rights, sharing your story and inspiring others to do the same. Together we can change the culture within the insurance carriers. But we must be heard in order to affect change.

Know the details about your plan

  • Name
  • Administrator
  • Plan number
  • Member ID number

Collect the facts

  • Specific benefits denied
  • Dates of denial
  • Reason for denial

Request information from the plan
By law you are entitled to information about how it decides

  • Non-quantitative treatment limitations
  • Medical necessity criteria
  • Reason for denying benefits
  • New and additional evidence used to make decision 

Appeal the benefit denial

  • Call the plan. (locate # on the back of your card)
  • Explain how the plan has violated parity
  • Ask them for the address to submit a written appeal
  • Send letter with the following information 
  • Facts about the denial
  • Explanation of parity violation

Continue the appeal process
Don’t give up if first step is not successful.

  • Ask plan if there is an external review process If so follow those steps
  • File a complaint and a request for a review with your state’s Insurance Commission
  • TELL US YOUR STORY

We want to hear from you. We are stronger together. Together, we can affect change.