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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 10 years, it has not been fully implemented or enforced. As a result, families continue to face numerous barriers when seeking affordable care, may be illegally denied coverage, and struggle to navigate a complex and burdensome insurance process in a time of crisis.
Our recent 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 nearly 200 lives lost each day due to overdose.
We are working to identify problems and improve enforcement of the Parity Act as partners on the Parity at 10 Campaign. It’s important to know your insurance rights and recognize parity warning signs. If you feel like you’ve been unfairly denied coverage for addiction treatment, filing a complaint is a step toward better enforcement.
Better understand the law, and how you can more successfully appeal your health plan to provide needed coverage with this useful guide.
A new bill has been introduced in both houses of Congress to strengthen enforcement of the Parity Act. It would require federal agencies to provide needed oversight along with establishing a Consumer Parity Unit for families in crisis to get help, submit complaints and receive a timely response.