What Is Mental Health Parity?

The term mental health parity, as defined by the National Alliance on Mental Illness (NAMI), is the equal treatment of mental health conditions and substance use disorders in insurance plans. From laws and legislation to the benefits and services that must be covered, a lot goes into ensuring that parity is followed when it comes to healthcare treatment and costs. Below, we go over some of the specifics of mental health coverage and parity in the U.S. as outlined by NAMI.¹

Parity necessitates equal coverage, not necessarily good coverage.

Comprehensive parity stipulates that coverage must be equal, which means the quality of coverage is dependent upon your current insurance. If you have a limited health insurance plan, then the mental health coverage you receive will be limited as well. This is the case even if you live in a state with particularly strong parity laws—your level of mental health coverage is ultimately dependent upon your health insurance plan.

NAMI has created guidelines for navigating parity’s finer points. Its infographic “What Is Mental Health Parity”² provides the following information on boundaries, breaches, and appeals:

1. Health plans must follow either federal or state law—whichever is stronger.

   There are minimum standards that have been established across the U.S. due to the passing of the federal parity law. Individual states may have their own laws in place, from comprehensive, limited, and broad-based parity to minimum mandated benefit. However, if you live in a state that doesn’t have a strong parity law, your health plan is required to follow the federal law instead.

   Specific benefits and services must be covered equally, including:

   1. Group health plans for employers with more than 51 employees
   2. Most group health plans for employers with less than 50 employees
   3. The Federal Employees Health Benefits Program
   4. Medicaid Managed Care
   5. State Children’s Health Insurance Programs
   6. Some state/local government employee health plans
   7. Health plans purchased through the Health Insurance Marketplaces
   8. Most individual and group health plans purchased outside the Health Insurance Marketplaces

2. There are signs to watch out for that can indicate your health plan may be breaching parity requirements.

   For instance, if you are required to call and get permission to receive mental health care coverage but are not required to do the same for other types of healthcare. If you are unable to find in-network mental health providers who are taking new patients. If you notice there are higher costs or fewer visits for mental health services than for other services. These are all signs that your health plan may be violating parity requirements.

3. You can file an appeal for denial of services. In order to do so, the following steps should be taken:

   • Talk with your mental health professional or provider.
   • In the case of an emergency, ask your mental health professional to request an expedited appeal.
   • Confirm with your insurance provider that your services will be covered for the duration of the appeal.
   • Request a written explanation for the denial of service. Your provider may also make this request on your behalf.
   • Do your research to ensure your appeal letter meets all the necessary requirements.
   • Be sure to meet all deadlines in the review and appeal process.

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¹Source: www.nami.org/find-support/living-with-a-mental-health-condition/understanding-health-insurance/what-is-mental-health-parity
²Source: www.nami.org/NAMI/media/NAMI-Media/Infographics/MHParity10-23-15.pdf

Walden University is accredited by The Higher Learning Commission, www.hlcommission.org.