Under the Mental Health Parity and Addiction Equity Act (Parity Act) of 2008, most private and public insurers are required to cover mental health (MH) and substance use disorder (SUD) treatment in the same way they cover treatment for any other disease.
The Parity Act requires a health plan’s standards for substance use and mental health benefits to be comparable to – and no more restrictive than – the standards for other medical benefits.
Generally, this means that a plan cannot put more restrictive visit limits, impose higher cost sharing or apply more onerous prior authorization or concurrent review requirements on MH/SUD benefits as compared to similar medical or surgical benefits. Insurance is complicated but parity is simple. Parity means health plans must treat addiction like any other disease.
Although the Parity Act has been law for 15 years, families continue to face numerous barriers when seeking affordable care, including being illegally denied coverage and navigating a complex and burdensome insurance process in a time of crisis.
Our report, Uncovering Coverage Gaps II, found widespread non-compliance with the Affordable Care Act’s requirement to cover addiction treatment. Lack of access to effective and affordable treatment contributes to the approximately 300 lives lost each day due to overdose.
It’s important to know your insurance rights and recognize parity warning signs. You can also learn more through this parity guide for families and caregivers.
If you feel like you’ve been unfairly denied coverage for addiction treatment, filing a complaint is a step toward better enforcement. For assistance, you can contact the Department of Labor’s Benefits Administrators at 1-866-444-3272 or online.
Better understand the law, and how you can more successfully appeal your health plan to provide needed coverage with this useful guide.
Help Advance Parity in Mental Health and Addiction Care
Send a letter to your members of Congress encouraging them to cosponsor and support the Parity Enforcement Act to help achieve equitable coverage for addiction treatment.