The premise of parity is simple— insurance coverage for and access to mental health and addiction care should be no more restrictive than coverage for and access to other medical care.
Thanks to the Mental Health Parity and Addiction Equity Act of 2008, also known as the Federal Parity Law, today most health plans cover mental health and addiction treatment.
However, the rules and regulations implementing the Federal Parity Law are complex and confusing, and insurance companies continue to deny coverage or limit treatment options for those seeking mental health and addiction treatment.
Coverage denials or inadequate treatment can result in people trying to navigate a confusing insurance system while in the midst of a personal crisis; family members sacrificing retirement or college savings, or declaring bankruptcy,
to pay for treatment their insurance plans won’t cover; and people ultimately dying from overdoses or suicides due to lack of treatment.
States have primary enforcement authority over insurers in their states. Tennessee has passed legislation to strengthen the enforcement of the Federal Parity Law at the state level, but increased compliance and enforcement efforts are still needed to achieve true parity.
As rates of suicides and overdoses continue to climb in Tennessee, the continued fight for mental health parity is more important than ever.
Frequently Asked Questions
What is Parity?
With the passage of The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), most health plans are now required to provide mental health and addiction benefits on a comparable basis to benefits for other medical conditions. This includes most employer-sponsored group health plans and individual health insurance coverage. Most group health plans, Medicaid managed care organizations, State Children’s Health Insurance Programs and individual health plans sold in the Health Insurance Marketplace through the Affordable Care Act (ACA) are required to follow federal parity mandates.
Parity in Tennessee
Filing a Complaint
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.