Know Your Rights: Fair Insurance Coverage for Mental Health

Federal law is clear that health insurance companies cannot discriminate against people seeking care for mental illness or addiction. But how do you know if your insurance company is not complying with the law? What can you do if you suspect a violation?

The American Psychiatric Association (APA) created a tool to help answer these questions. The poster titled, “Fair Insurance Coverage: It’s the Law” (Spanish-language version), clearly and simply explains the law and the steps to take if you suspect a violation.

The poster is intended to help enforce federal law and end discrimination.  Print it out and share the link (www.psychiatry.org/parity).

By understanding your rights and taking action you can help ensure fair coverage for yourself and your family, and you can help others by holding insurance companies accountable.

What Federal Law Requires

The Mental Health Parity and Addiction Equity Act requires any group health plan that covers more than 50 employees and offers mental health and/or substance use disorders coverage to provide that coverage with no greater financial requirements (such as co-pays, deductibles, annual or life-time dollar limits) or treatment limitations than the requirements the plan applies to medical / surgical benefits. 

Also, under the Affordable Care Act, new individual and small group plans in and outside of the mandated health insurance exchanges are required to offer mental and substance use disorder coverage similar to medical/surgical benefits.

In addition to federal law, 49 states and D.C. currently have laws relating to insurance coverage for mental health and substance use.  More information, including a summary table of state laws, is available from the National Conference of State Legislators.

By Deborah Cohen, senior writer, American Psychiatric Association

Fight for Your Right to Behavioral Health Benefits

By Carol McDaid, Co-Chair of the Parity Implementation Coalition

In 2008, Congress passed a law that requires health plans to provide benefits for addiction and mental illness that's equal to other medical benefits. Unfortunately, many people still don't know about this law called the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (named after two bipartisan senators who experienced addiction/mental illness in their families).

Parity is personal to me. Did you know that 23 million people have a diagnosed substance use disorder but fewer than 10% receive any help for that condition? I am one of the lucky ones who got the treatment I needed to recover. When my insurance failed twice to provide the coverage promised in my employer-provided health benefit package, I got support from family and employers to help pay for the care I deserved.

When my insurance company refused to pay for any of my last residential treatment (after years of failed attempts at outpatient programs), I fought back. I used all of my internal and external appeals rights. It took me three years and a blizzard of paperwork, but one day a check for half of my treatment appeared in the mail.

Sadly, the average American family with a loved one suffering from addiction or mental illness lacks the resources to fight a three year battle with their insurer to get benefits they are entitled to - by law. Often afraid to discuss their illness with employers, they suffer in silence rather than using their behavioral health benefits promised by insurers. These victims become sicker and even unemployable – causing the burden of paying for their treatment to be shifted to the public sector, where taxpayers like you and me are forced to pick up the bill for health plans that simply will not pay their fair share.

Today, I use my skills as an advocate and former employee benefits analyst to fight for the rights of those coping with addictions and mental illnesses. I'm driven by the passion of my personal parity experience with insurance discrimination and my sense of justice and equality. Help for these conditions should not be limited to those who can afford to pay out-of-pocket or have the fortitude to fight long battles with insurers.

If you or a loved one have been unable to get your insurance to pay for addiction or mental health treatment, please share your story. 

I've been in the halls of Congress fighting this fight since 1993. I realize that laws and regulations are complex and often take many years to be fully implemented. I intend to fight this fight as long as it takes to end insurance discrimination against people suffering from addiction and mental illness. But, to be successful, we need your stories and a collective sense of outrage.

Join me. Share your personal parity story by sending an email to hsf@psych.org. Fight for your rights. Every 15 minutes in the U.S., someone dies from suicide. The clock is ticking.

Petitions by iPetitions.com

Tweet