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Under the Mental Health Parity and Addiction Equity Act (Parity Act) of 2008, private and public insurers are obligated to provide comprehensive and equitable coverage for substance use disorder and mental health benefits (SUD/MH) for their customers.
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 benefits or surgical benefits.
Unfortunately, though 10 years have passed, the Parity Act has yet to be readily implemented and enforced. Families continue to struggle with navigating the insurance process for addiction treatment and are unfortunately illegally denied coverage in many cases. There’s even a list of common violations, it happens so frequently. The good news is that organizations, including the Partnership for Drug-Free Kids, are working to make implementation and enforcement a reality. If you feel like you’ve been unfairly denied from addiction insurance coverage, you can file a complaint.
You can reference this useful guide to better understand the legislation, and how you can more successfully appeal your health plan to provide needed coverage.
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