Keller Rohrback Investigates Insurance Plans That Unlawfully Deny Mental Health And Substance Abuse Claims

The federal Mental Health Parity and Addiction Equity Act (MHPAEA) requires health plans that cover mental health and substance use disorder treatments (together, behavioral health care) do so on equal terms to the medical and surgical care provided by the plan. This means that plans may not impose higher co-pays or deductibles. It also means that a plan may not impose limits on behavioral health care that are stricter than the limits placed on medical care (for example, by limiting the number of psychiatrist visits covered when it does not limit visits to other types of physicians).

Many states have laws providing even greater protections for individuals in need of behavioral health care. In these states, health plans may be affirmatively required to provide care that is medically necessary to treat mental health or substance use disorders.

Have you recently been denied approval of claims for mental health and/or substance abuse treatment? If so, there are several active steps you can take and remedies under the MHPAEA or State law that may be available to you. Keller Rohrback is dedicated to ensuring individuals in and seeking recovery from substance use and mental health disorders can access the benefits promised to them under the law.

If of the following have happened to you, please contact please contact Keller Rohrback L.L.P. to determine whether you may have claims under MHPAEA or state law:

  • Been denied behavioral health services because the plan determines that they are “not medically necessary,” even though your mental health care provider indicates that they are.
  • Faced limits on ability to access behavioral health care such as limits on the number of visits, hours or days of treatment.
  • Paid higher copays or deductibles for behavioral health care than medical or surgical care.
  • Otherwise been denied access to behavioral health care by your health plan.

Once you have been denied benefits you may have only a short period of time to appeal this denial. To ensure that you are not waiving important legal rights, it is important to contact us promptly after receiving any denial of benefits.

Resources

Know Your Rights: Parity for Mental Health and Substance Use Disorder Benefits, available at https://www.dol.gov/ebsa/pdf/mental-health-benefits-061016.pdf

Mental Health and Substance Use Disorder Parity Task Force, available at www.hhs.gov/parity

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