Mental Health Parity Violations: Insurers Break This Law Constantly. Here's How to Fight It.

The Mental Health Parity and Addiction Equity Act requires that insurance companies treat mental health and substance use disorder benefits equally to medical and surgical benefits. In practice, this law is violated constantly, and most patients do not know they have specific legal protections when their mental health treatment is denied inappropriately.

If your insurance company denied coverage for psychiatric medication, imposed prior authorization requirements on your antidepressant, limited your therapy sessions, or required you to try multiple cheaper alternatives before approving a mental health medication that your doctor recommended, you may have experienced a parity violation.

Understanding what mental health parity actually requires, how to recognize violations, and what you can do about them can help you get the mental health care you need.

What Mental Health Parity Actually Requires

The Mental Health Parity and Addiction Equity Act, passed in 2008 and strengthened by subsequent regulations, requires that group health plans and health insurance issuers provide mental health and substance use disorder benefits that are no more restrictive than medical and surgical benefits.

This means several specific things:

Financial requirements must be equivalent. If your plan has a $20 copay for a primary care visit, it cannot have a $50 copay for a mental health visit. If your deductible for medical care is $1,000, your deductible for mental health care must also be $1,000.

Treatment limitations must be equivalent. If your plan does not limit the number of cardiology visits you can have per year, it cannot limit the number of therapy sessions. If your plan does not require prior authorization for diabetes medications, it cannot automatically require prior authorization for all antidepressants.

Managed care techniques must be applied equally. If your plan uses step therapy for certain medical conditions, it can use step therapy for mental health conditions, but the criteria and process must be substantially equivalent.

Ellen can help you document parity violations and file complaints with the right agencies. Start here →