Recent federal laws have expanded health insurance coverage of mental health and substance use disorders, but accessing that coverage can be difficult and complicated. Many barriers still exist and challenges can vary from state to state. To enforce the law, federal and state agencies need to hear from you about possible violations. A number of new resources are available to help you understand your rights to coverage under the law and to get access to the coverage you deserve.
If you’ve been denied coverage, had limits set on behavioral health services, or are being charged more for behavioral health services than general medical services, that may be a violation of the law. But how do you know if it’s a violation and what can you do about it?
“How to File a Complaint” and Poster on the Law
The American Psychiatric Association has developed a poster, Fair Insurance Coverage: It’s the Law (available in English and Spanish) that outlines the patient rights under federal law.
APA has also developed step-by-step guidance and template letters to help you file a complaint. Depending on the type of insurance you have, you will need to file a complaint with the U.S. Department of Health and Human Services, the U.S. Department of Labor, or your state insurance commissioner. See instructions on how to file a complaint.
Parity Tracking Website
A new website, Parity Track, can also help you understand your rights under federal and state law. It provides simple explanations of common parity violations, such as “I have limits on how many times I can see a behavioral health provider” and “I am being charged more for prescription medication for behavioral health treatment than I am for prescription medication for other treatments.”
The site includes federal and state-by-state breakdown of parity legislation, regulations and litigation (see map below). It also has stories from across the country and highlights of some promising state initiatives. For example, new legislation in Missouri specifies how insurance plans should cover eating disorder treatment. New legislation in Maryland requires coverage of partial hospitalization for behavioral health treatment at the same terms as for other medical treatment.
Parity Resource Guide
A recently updated resource guide can help. The Parity Implementation Coalition* in conjunction with The Kennedy Forum recently published an updated version of the Parity Resource Guide for Addiction & Mental Health Consumers, Providers and Advocates, Simplifying the Appeals Process: Strategies for Winning Disputes with Your Health Plan.
The guide provides information for patients and families on the steps they can take to ensure they receive the same type of insurance coverage for mental health and substance use treatment as they receive for physical illnesses. It breaks down and simplifies the process and terminology, such as what a parity violation looks like and how an individual should initiate an appeal. It also explains medical necessity in regards to mental illness and the appeals process.
Parity Implementation: Legislation, Regulatory Action, Litigation from Parity Track
*The Parity Implementation Coalition was formed to help ensure that the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is properly enforced and to end discrimination against individuals and families who seek services for mental health and substance use disorders. Members of the Coalition include the American Psychiatric Association, American Society of Addiction Medicine, Mental Health America, National Alliance on Mental Illness and others.