The Mental Health Parity and Addiction Equity Act is well-known among those in the behavioral health field. However, for those who are not familiar with the act, it can be a multifaceted and confusing topic.
Enacted in 2008, the Mental Health Parity and Addiction Equity Act does not require a plan to offer mental health or substance use disorder benefits. However, if the plan does offer these benefits, they must fall in line with those offered for other medical care.
One illustration of a parity requirement involves the frequency of office visits. Under the act, patients do not necessarily need medically necessary appointments. Under plans that follow the parity act, insurers cannot limit the number of visits a patient needs for counseling – similarly to how you cannot regulate the number of emergency room visits a person needs for urgent care.
Treatment center personnel, from case managements to psychiatrists, should fully understand this law as well as how to handle violations. Ultimately, the goal is not to report violations, but to work with insurance companies, and find common ground so that those most in need, the patients, are helped.
One in four people will develop a mental disorder in their lifetime, and many will suffer from drug abuse and/or addiction. When these patients need access to treatment, they should not be stonewalled by an insurance representative telling them when they do or do not need help.
Across the medical field, some individuals do take advantage of insurance upcoding. Still, violations and the denial of benefits should be commonplace as a result of these “bad apples.” When an insurance company decides to stop paying claims due to audits, it becomes difficult for treatment centers to continue doing their work. Operational problems persist and some patients may be turned away when their insurance cannot be used. Ultimately, this becomes a public health concern.
If you have been denied treatment, had your counseling sessions limited or have been required to pre-authorize outpatient services, you may have experienced a violation of the Parity act.
Common violations can be found at https://www.paritytrack.org/know-your-rights/common-violations
. If you decide to report a violation, be sure to have your call center verify the call and record the phone call for accuracy. However, both parties must be aware that the phone call is being recorded. During the conversation, be sure to have the name of the insurance representative and an explanation of the violation.
For violations involving a state-governed plan, contact the Florida Department of Insurance
. You can also call the Consumer Helpline at 1-877-693-5236, however, they do prefer to speak with the patient for any health-related issues.
Violations involving plans governed by federal law must be reported to the Centers for Medicare & Medicaid Services and the state Department of Health & Human Services.