If you or someone close to you has been denied coverage for behavioral health services, your rights may have been violated. Find support resources in your state through our partner, ParityTrack.

If you or someone close to you has been denied coverage for behavioral health services, your rights may have been violated. Find support resources in your state through our partner, ParityTrack.

[Content to leverage from state advocacy draft:]

Mental Health and Substance Use Disorder Parity

When you break your leg, or are diagnosed with diabetes, accessing treatment is straightforward. It is fairly easy to locate a provider and treatment is often covered by your insurance plan.

But when it comes to accessing behavioral health care, the process is more challenging. It’s common to contact a provider and find out that they are not accepting more patients. Denials of care are frequent. Even when treatment is covered, frequently your insurance plan will make you jump through hoops to get approval. Appealing denied coverage requires time and resources that are unavailable to most individuals and families experiencing a behavioral health crisis.

Parity laws exist to remove these barriers to care. Yet many of the protections within these laws remain unrealized.

It’s important that you understand your protections so that if you think you’re experiencing a violation, you can report it.

Shatterproof is proud to partner with ParityTrack to advocate for nationwide implementation of parity. Together, we have created this document to help you determine if you or your loved one may have experienced a parity violation.

What is parity?

Parity is about fairness. Traditionally, health insurance has been more restrictive for behavioral health care than for all other forms of health care. As a response, the federal government and state governments passed parity laws. These laws mandate that insurance plans cover behavioral health treatment the same way they cover any other medical care.

What is the Federal Parity Law?

The Mental Health Parity and Addiction Equity Act (MHPAEA), passed in 2008, is our country’s most important parity law. It’s a federal law that requires many insurance plans that offer behavioral health coverage to provide that coverage with the same terms and conditions as other medical coverage. The law doesn’t require insurance plans to cover behavioral health services, but if they do cover it, then it has to be equal with other medical coverage.

Most insurance plans have to obey the Federal Parity Law, and both the federal government as well as state governments are responsible for enforcing the law.

What are state parity laws?

State laws may require insurance plans to provide behavioral health coverage at the same terms and conditions as other medical coverage. These parity laws can be very different from state to state, in terms of how much they require of insurance plans and to which plans they apply. Some state parity laws require insurance plans to provide more coverage than the Federal Parity Law, and some state laws do not. Whenever both a state parity law and the Federal Parity Law apply to the same insurance plan, the insurance plan has to abide by whichever law requires more coverage.

What are some of the most common parity law violations?

  • A higher copay or out-of-pocket cost for mental health and substance use disorder services than for other medical care
  • Limits on how many days you can stay in a treatment center, or how many times you can see a provider—when your plan doesn’t have such limits on treatments for other medical issues
  • Denials by your insurance plan because they claim the treatment is not “medically necessary”—this type of denial may not be a parity violation, but you should always ask your insurance plan, and the appropriate regulatory agency, if the way your plan made this decision complies with the Federal Parity Law
  • A requirement to try another form of treatment before your insurance plan will cover the treatment recommended by your doctor

What are my parity rights?

Your parity rights can be very complex, but you have several basic rights:

  • Your insurance plan can NEVER require that you pay higher copays or coinsurance for behavioral health services or medications than you would pay for other, similar medical services or medications
  • Your insurance plan can NEVER impose limitations on your treatment for a behavioral health condition that are not in place for treatment of other medical conditions
  • Your insurance plan can NEVER decide whether your behavioral health treatment is medically necessary or not, in a way that is different from how it decides if any other medical treatment is medically necessary
  • You can ALWAYS ask the government to investigate your denial of coverage to see if it violates parity laws

I think I, or a loved one, was denied coverage in violation of the parity law. What should I do?

First, file a consumer complaint with ParityTrack. When you do, you’ll directly help others with mental health and substance use disorders get equal access to care and treatment.

Second, complain to government regulators and ask them to determine if your denial or restriction of care is in compliance with the Federal Parity Law. There are multiple different state and federal regulatory agencies that could be responsible for enforcing the law. Find your state on this map and click on it to get the contact information for the agencies in your state. To decide which agency is relevant for you, call your insurance plan and ask which agency you should contact. If your insurance plan will not give you this information or gives you the wrong information, please include that in your complaint with ParityTrack.

And, remember: You always have the right to appeal a denial of treatment. There are several levels to the appeals process, and it is important to be organized and follow the appeal rules very carefully. For more information on the appeals process, click here.