Although the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) was enacted over four years ago, a final rule implementing the law has not yet been issued. Without a final rule from the Administration, many individuals seeking care for mental health and addictive disorders have been unable to access the health care services they need.
The Administration has promised a final MHPAEA rule by the end of the year, but they have not clarified if the needed protections will be in the final rule. The Administration needs to hear from patients and providers who have experienced parity violations so that these practices are clearly prohibited in the final rule. Parity violations include plans denying or more strictly managing mental health and addiction treatment services than other services covered by the plan. More information may be found at www.parityispersonal.org.
Send an email describing your parity violation story to both the Departments of Labor and Health and Human Services. We encourage stories to be reported by either patients or providers who are dealing with the parity issue. A sample template is below. Be sure to tell your personal story and attach any relevant documents (if available) such as a denial letter, summary of benefits or other materials provided by the health plan.
To assist you with understanding the common problems with parity that other providers or consumers have registered, see the below examples:
1. Outpatient sessions are being limited by utilization review (also known as medical necessity review) and this is not being done for medical and surgical conditions.
2. Provider reimbursement rates are too low, so the provider has to offer services out-of-network and the patient has to pay a higher out of pocket for their treatment.
3. The insurance company has labeled my treatments as “experimental” and therefore are refusing to pay for those treatments, leaving the patient to pay 100% out of pocket, or go without.
4. The insurance company says that my plan does not cover residential treatment or intensive outpatient care.
5. The insurance company says that my plan does not cover inpatient or residential treatment unless it is provided in an acute care hospital, but most of the treatment providers are non-hospital based facilities.
6. The insurance company says that they do not authorize any inpatient treatment at all for my opioid addiction, and that I must detox on an outpatient basis.
7. I have requested from my insurance company the reason why they have denied my care and they will either not respond to my requests for further information, or they refuse to tell me what they do for medical and surgical care, or they refer me to an enormous website that I cannot discern any information from.
Send your email to:
Be sure to also send a copy of your message to firstname.lastname@example.org!
You can, in addition to your email, place your complaint over the phone by calling the Department of Labor at 866-444-3272 or the Department of Health and Human Services’ Center for Insurance Information and Oversight at 877-267-2323 ext 61565. Be sure to obtain a tracking number for your complaint to be sure it is actually registered in their system and so that you can track your complaint.
Sample E-Mail Template
I am writing to submit a possible violation of the Mental Health Parity and Addiction Equity Act (MHPAEA). My [health plan/my patient’s health plan] has imposed discriminatory limits on [my/his/her] [addiction/mental health] benefits that I do not believe are imposed on medical benefits. I have attached a copy of the denial letter (if there is one).
[Insert personal story; and if you can, please include details such as the specific service(s) the plan is not covering.]
Please inform me of any processes or procedures I must take to have this complaint filed and registered in your system. Please provide me with a tracking number so that I may track my complaint.
Should you require additional information, please do not hesitate to contact me at [phone number]. I look forward to hearing from you in the near future.
Thank you for your attention in helping me to resolve this complaint, so that I can access treatment services I need [or so that I can assist my patient in accessing medically necessary services], as intended by the federal parity law.
Sample Phone Script
I am calling to report what I believe is a violation of the Mental Health Parity and Addiction Equity Act (MHPAEA). My [health plan/my patient’s health plan] has imposed discriminatory limits on [my/his/her] [addiction/mental health] benefits that I do not believe are not imposed on medical benefits. The plan is not covering [tell them specific service(s)].
Please tell me what I must to do have this registered as a formal complaint under MHPAEA and what the next steps will be toward resolving it.