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:
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:
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.