What mental health parity means for your insurance coverage

In the past, many health insurance plans didn't cover mental or behavioral health treatments. This is because these services weren't viewed as healthcare in the same way that things like having surgery or getting an X-ray might be. 

The result was that many people couldn't access critical support from therapists, psychiatrists, or other mental health professionals. Paying out of pocket for mental healthcare can be costly, and many people simply can't afford out-of-network providers or treatments. 

However, thanks to the Mental Health Parity and Addiction Equity Act of 2008, today there are more protections for mental healthcare benefits. Rula shares information to help you learn more about your rights under this legislation and how they can help you and your family use your health insurance to access the mental healthcare you deserve.

Key Takeaways

• The Mental Health Parity and Addiction Equity Act of 2008 requires health insurance plans to provide coverage for mental healthcare that's similar to the coverage they provide for physical healthcare.
• Most health plans are legally required to ensure that copays, visit limits, and prior authorization processes for mental healthcare are comparable to those for physical healthcare.
• If you're concerned that your health plan isn't meeting parity requirements or has incorrectly denied coverage, you can file an appeal through your insurance provider's appeals process. You can also ask for help from your healthcare provider or a patient advocate, or you can contact your state's insurance department or the U.S. Department of Labor for assistance.

What Is the Mental Health Parity Act?

The Mental Health Parity and Addiction Equity Act required insurance companies to change the way they cover mental healthcare. 

Some of the protections the legislation provides include:

• Your copays for mental health or substance use treatment must be similar in cost to copays for physical healthcare.
• Health insurance plans can't limit the number of times you receive outpatient mental healthcare within a benefit period (i.e., the number of times you go to therapy) if they don't have similar limits on the number of times you can access outpatient physical healthcare.
• If your health insurance plan requires prior authorization for mental health or substance use treatment, it must be comparable to those for physical health services. 

Which Plans Are Covered Under the Parity Law?

The parity law requires most health plans to include mental health benefits, including:

• Employer-sponsored health plans for employers with over 51 employees
• The federal employee health benefits program
• Medicaid-managed care plans
• State children's health insurance programs
• Some state and local government health plans
• All health plans purchased through the health insurance marketplace (also referred to as ACA plans)
• Most individual and group health plans purchased outside the health insurance marketplaces 

What mental health benefits does insurance have to cover?

While there are some exceptions, under the Mental Health Parity Act, most health plans are required to cover:

• Outpatient mental and behavioral health treatment (i.e., therapy or counseling)
• Inpatient mental and behavioral health treatment (i.e., partial hospitalization programs)
• Substance use disorder (SUD) treatment programs (also referred to as rehab or addiction treatment)
• Care for all pre-existing mental health conditions, with access starting on the day coverage begins (no waiting period for individual or small group plans under the Affordable Care Act)

Before accessing mental healthcare, it's important to understand your coverage so you can anticipate what costs you might be responsible for. 

If you have questions about your benefits, reach out to your insurer and ask for an explanation of your coverage for mental health services. There's usually an 800 number on the back of your insurance card you can call.

How to Tell if Your Insurance Plan Follows Parity Requirements

If your health insurance company has denied coverage for mental healthcare, the following signs could indicate that it's not following the parity law, and you may have the legal right to demand payment or compensation.

• The cost of mental health services is much higher than physical health services under your plan.
• You're entitled to fewer covered mental healthcare appointments than physical health appointments.
• You've been denied coverage for mental healthcare because your plan deemed that it wasn't a "medical necessity." However, the insurer isn't able to provide the criteria it used to make that determination.
• There are plenty of in-network providers for physical healthcare. But your plan has few, if any, in-network mental or behavioral healthcare providers.
• Your plan doesn't cover inpatient mental health, substance use treatment, or intensive outpatient care. But it does cover that level of care for other health conditions.

If you suspect that your health plan isn't following the parity law, start by contacting your insurer to discuss your concerns. They might be willing to give you more details about why your claim was denied.

If you still think your plan might be in violation of parity requirements, contact your insurer's customer relations department to initiate a formal appeal. Follow each step of your insurer's appeals process and be sure to save copies of all the documentation you submit. 

If you need additional support, you can also use this guide to help fight coverage denials for mental healthcare from the National Alliance on Mental Illness. You can also ask for help from your healthcare insurers' patient advocate or contact your state's insurance department or the U.S. Department of Labor for assistance.

This story was produced by Rula and reviewed and distributed by Stacker.