In the past, many health insurance plans did not cover mental or behavioral health treatments because these services were not traditionally considered part of healthcare like surgeries or X-rays. This led to limited access to crucial support from therapists, psychiatrists, and other mental health professionals, as many people could not afford out-of-pocket costs.
Fortunately, the Mental Health Parity and Addiction Equity Act of 2008 now provides more protections for mental healthcare benefits. This legislation ensures that mental healthcare coverage is similar to that for physical healthcare, including copays, visit limits, and prior authorization processes.
If you believe your health plan is not meeting parity requirements or has denied coverage incorrectly, you can file an appeal through your insurance provider or seek assistance from healthcare providers, patient advocates, state insurance departments, or the U.S. Department of Labor.
The Mental Health Parity and Addiction Equity Act mandates that insurance companies offer comparable coverage for mental health and substance use treatment as for physical health services. This includes similar copays, visit limits, and prior authorization requirements.
Most health plans, including employer-sponsored plans, federal employee programs, Medicaid, state children’s health insurance programs, and ACA plans, are subject to the parity law. These plans must cover outpatient and inpatient mental health treatment, substance use disorder programs, and care for pre-existing mental health conditions.
Overall, the Mental Health Parity Act aims to ensure that individuals have access to essential mental healthcare services without facing financial barriers or discrimination.
Before seeking mental health care services, it is crucial to have a clear understanding of your insurance coverage to prepare for any potential costs you may be required to cover. If you have inquiries regarding your benefits, reach out to your insurance provider and request an explanation of your mental health services coverage. Typically, there is an 800 number printed on the back of your insurance card that you can contact.
Identifying Whether Your Insurance Plan Complies with Parity Regulations
If your health insurance provider has denied coverage for mental health services, certain indicators may suggest that it is not adhering to parity laws, granting you the legal right to seek payment or compensation.
– The expenses for mental health services significantly exceed those for physical health services in your plan.
– Your plan allows for a limited number of covered mental health appointments compared to physical health appointments.
– Coverage for mental health services has been declined by your plan deeming it not a “medical necessity,” without providing the criteria used for this decision.
– While there is a wide network of in-network providers for physical health care, the availability of in-network mental or behavioral health care providers under your plan is scarce, if any.
– Your plan excludes coverage for inpatient mental health care, substance use treatment, or intensive outpatient care while covering these levels of care for other health conditions.
Should you suspect that your health plan is not complying with parity laws, begin by reaching out to your insurance provider to address your concerns. They may offer further insights into why your claim was rejected. If you remain convinced that your plan is violating parity requirements, engage with your insurer’s customer relations department to launch a formal appeal. Follow the insurance company’s appeal process diligently and retain copies of all documents you submit.
For additional assistance, refer to resources like the National Alliance on Mental Illness guide to combat coverage denials for mental health care services. Seek support from your insurer’s patient advocate or contact your state’s insurance department or the U.S. Department of Labor for further guidance.
This content was created by Rula, and reviewed and shared by Stacker.
