NAMI
National Alliance on Mental Illness
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Does your plan cover mental health services fairly?

In 2014, most health insurance plans, including Medicaid managed care plans, must comply with the federal parity law and provide fair coverage of mental health services.

5 signs your plan may be violating parity requirements

  1. You have to pay more or get fewer visits for mental health services than for other kinds of health care.
  2. You have to call and get permission to get mental health care covered, but not for other types of health care.
  3. You have been denied mental health services because they were not considered “medically necessary,” but your plan does not answer your request for the medical necessity criteria they use.
  4. You cannot find any in-network mental health providers that are taking new patients, but you can for other health care.
  5. Your plan will not cover residential mental health or substance use treatment or intensive outpatient care, but they do for other health conditions.

If you think your plan has violated parity requirements, you can communicate with your plan or file an appeal using the Parity Toolkit. You can also get help with questions about whether your health insurance plan is covering mental health services fairly by sending an email to info@mentalhealthparitywatch.org.

7 steps to take for an appeal of a denial of services

  1. Ask your provider to help you.
  2. Make sure your provider requests a special expedited appeal if it is an emergency.
  3. Confirm with your insurance company whether your services will be covered during the appeal.
  4. Request, or have your provider request, written notification of the reason for denial. You should receive this within 30 days.
  5. Use the templates for letters in the Parity Toolkit.
  6. Make sure that you and your provider meet all deadlines in the review or appeals process.
  7. If you are on Medicaid, you may request a “state fair hearing” at the same time you file your appeal.

For more information, download the Federal Parity Fact Sheet

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