Mental Health Parity Action
It is urgent and essential that PPAC members play a role in assuring that mental health Parity is applied consistently and equally across the insurance spectrum. Consequently PPAC suggests the following guidelines for mental health professionals to monitor and advocate for mental health Parity in California:
Recommendations for Filing Mental Health Insurance Parity Complaints
The two most common reasons for appeals are lack of access to a contracted or network provider and denial of coverage for a recommended treatment (office visits, medication or hospital days).
1. TALK TO THE PLAN FIRST. The patient and/or physician needs to use the appeals and grievance system offered by the insurance company or health service plan first. Keep records of phone calls (date, time, subject, and disposition) made or written appeals filed. Advise the plan representative of your intent to pursue your additional appeal rights with the Department of Managed Health Care/State regulator. Note: CMA members have added resources for claims issues*.
2. CALL OR EMAIL THE REGULATOR SECOND. If the insurance company or health plan fails to respond in a timely fashion, or if they inappropriately deny care despite your appeal, file a complaint with the Department of Managed Health Care Help Center at www.dmhc.ca.gov or 1-888-466-2219. (Note that the Help Center can expedite appeals identified as urgent). Also, note that if the insurance turns out to be the responsibility of the Department of Insurance (or other agency) the DMHC Help Center will pass it on to the appropriate agency.
3. MATERIALS TO SUPPORT YOUR APPEAL. You should attach a copy of the insurance company's denial letter or bill, or other pertinent documents if available, to DMHC. The web-based complaint form allows you to attach these documents.
4. PRINT OR ASK YOUR PATIENT FOR A COPY OF YOUR COMPLAINT. If the complaint is submitted electronically through the website, a copy MUST be printed before you hit the send button – you will not be able to print once you hit send. Keep that copy safe for reference.
5. NOTIFY PPAC. Randall Hagar is tracking trends in complaints. So please send him a copy of the complaint. He can also help you facilitate investigations.
6. LET US KNOW THE OUTCOME. Let Randall Hagar know the result of any investigation and/or adjudication whether you win or lose on your complaint. We will be monitoring those trends as well.
*CMA Reimbursement assistance services for PPAC Members: economicservices@cmanet.org; hotline (888) 401-5911; http://www.cmanet.org/resources
copyright Randall Hagar 2020