Mental Health Parity

If you have private health insurance, you should be aware of mental health parity. Parity requires health insurance plans to cover treatment for mental health and substance use disorders in the same way as treatment for other health conditions.

There is a federal mental health parity law, the regulations are in effect, as well as a Minnesota law that has been in place for a number of years. Unfortunately, these laws typically do not apply to health insurance offered to individuals and through small employers (under 50 employees individual policies except through MNsure), or Medicare or Medicaid.

Parity laws do not require a health insurance plan to cover mental health and substance use treatment but do require plans that cover these treatments to cover them in the same way as other health conditions.

If a plan has to follow the parity law, it must treat mental health and substance use disorders in the same way as other conditions in three main areas:

1. ARBITRARY TREATMENT LIMITS—cannot limit mental health visits if the same limits do not apply to treatment for other conditions.
2. OUT-OF-POCKET COSTS—cannot have higher co-pays, deductibles, or maximum out-of-pocket costs for mental health or substance use treatments compared to treatment for other conditions.
3. NONQUALITATIVE TREATMENT LIMITS (NQTLs)—Must offer same or similar services. For example if a health insurance plan covers rehabilitative services for physical health conditions, they must also cover rehabilitative mental health or substance use disorder services. Under state law, the Department of Commerce now has the authority to request information from the health plans to determine whether the plans are using NQTLs more restrictively to limit mental health and substance use disorder benefits.

In order to file a mental health parity complaint through the Department of Commerce, you can fill out an online form at https://mn.gov/ commerce/consumers/file-a-complaint/. Using this form, you should register a complaint on Life/Health Insurance and then specify the specific issue that you are having. If you are having trouble navigating the Department of Commerce website, you can also call their Consumer Services Center at 651-539-1600. If you are an individual or small group HMO policy enrollee, then you should contact the Department of Health at 651-201-5100 or 1-800-657-3916. 

Federal parity also applies to the criteria used by health insurers to approve or deny mental health or substance use treatment. The standard for “medical necessity determinations”—whether the treatment or supplies are considered by the health plan to be reasonable, necessary, and/or appropriate—must be made available to any current or potential health plan member upon request. The reason for denials of coverage must also be made available upon request. Under state law, the Department of Commerce now has the authority to request information from the health plans to determine whether the plans are using NQTLs more restrictively to limit mental health and substance use disorder benefits.

Federal law bars health plans that offer mental health benefits from setting annual or lifetime limits differently than limits for other medical benefits. Under Minnesota law, health plans licensed by the state cannot have higher co-payments or different limits for mental health or chemical dependency services than other medical services.

Here are some signs your health insurance plan may be violating parity laws:
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• You have to pay more or get fewer visits for mental health services than for other kinds of health care.
• You have to call and get permission to get mental health care covered, but not for other types of health care.
• 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.
• You cannot find any mental health providers in your insurance plan’s network that are taking new patients, but you can for other types of health care.
• Your plan will not cover residential mental health or substance use treatment or intensive outpatient care, but they do for other health conditions.
• Your plan covers new FDA treatments of other healthcare conditions but not mental illnesses.

If your health plans denies coverage for your mental health or substance use disorder treatment, you can appeal it and ask for more information about why your treatment was denied. Should your health plan deny coverage upon review and you believe this violates mental health parity, then you should contact the Minnesota Department of Commerce at 651-539-1600, MN Department of Health or the US Department of Labor at 1-866-487-2365. To learn more about parity laws, visit www.nami.org/parity, paritytrack.org or parityispersonal.org. Those websites will also have resources for filing a complaint if you have a self-insured plan through your employer that may not be following parity laws. Please call NAMI Minnesota as well at 651-645-2948.

Author: NAMI Minnesota

This content was taken from NAMI Minnesota's Hope for Recovery booklet. View more of their publications, here.