Although the government is responsible for regulating the insurance industry, it is your responsibility as a customer to report potential issues. If you believe your insurance carrier is not providing equal coverage for mental health, 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.
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Collect the details about your plan and the denial
Member ID number
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, and
- 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 for the address to submit a written appeal.
Send an email or letter with the following information
- facts about the denial, and
- explanation of parity violation.
Sample Letter to Insurance Plan N:\NDMDA\PROGRAMS\Web IMPORTANT\DBSAlliance.org\DBSA_REVAMP_2018\Assets\pdfs\advocacy
Ask your provider to act on your behalf and contact the plan to provide additional supporting evidence.
- Continue the appeal process.
- Don’t give up if your first step is not successful.
- Ask the plan representative 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.
Find Your State Insurance Commission
Sample Letter to Insurance Commission N:\NDMDA\PROGRAMS\Web IMPORTANT\DBSAlliance.org\DBSA_REVAMP_2018\Assets\pdfs\advocacy