Insurer violations of mental health parity laws can take many forms, including placing limits on how long and how often patients can receive care, providing insufficient networks of mental health providers, and more.
Most people are unaware that a parity violation has ever occurred. If you know what to watch out for, you will be better equipped to assert your rights.
What does a parity violation look like?
Common parity violations include:
- Fewer visits or days covered for mental health or addiction care.
- Residential or partial hospital care not covered for mental health or addiction. Example: Addiction residential care is not covered, but a skilled nursing facility is covered for stroke
- Higher out-of-pocket costs for mental health or addiction care. Example: the copay for a mental health therapy visit is higher than copay for an endocrinologist for diabetes.
- Separate deductible for mental health or addiction care on top of the overall deductible. A deductible is the amount you are responsible for before the health plan begins to pay.
- More frequent denial for mental health or addiction care than for other medical care because the health plan determines that the care is not medically necessary.
- Prior approval required more often for mental health or addiction care than for medical care.
- Step therapy: The least expensive mental health or addiction treatment is required before the prescribed care can be considered.
- In-network mental health or substance use providers not available and the health plan does not pay for the out of network providers in your local area.
For more information about warnings signs that a plan or issuer may be imposing an impermissible Non-Quantitative Treatment Limitation (NQTL), review the Department of Labor’s publication Warning Signs- Plan or Policy Non-Quantitative Treatment Limitations (NQTLs) that Require Additional Analysis to Determine Mental Health Parity Compliance.