Physicians and mental health professionals have an important role to play in helping improve mental health parity for their patients.
What is Mental Health Parity?
Parity is about fairness. Mental health and addiction disorders are prevalent and costly, and health insurance is needed to provide financial protection and secure access to care for patients. State and Federal Parity Law was intended to address this. While the law does not require that all health insurance plans cover behavioral health care, if they do, the coverage must be comparable to what’s in place for other medical care. The Affordable Care Act (ACA) went further than the Parity Act and required plans to cover “essential health benefits” including services for mental health and substance use disorders.
And yet, still, Rhode Islanders with behavioral health conditions often have more difficulty getting the treatment and services they need when compared to other medical care. A recent study conducted by Milliman for Parity Track found that nationally, behavioral health patients are about five times (5x) more likely to have to go out of network – and thus pay out of pocket — for behavioral health outpatient care. The report also found that behavioral health providers are reimbursed an average of 20% less than primary care physicians and 16% less than other specialists, contributing to the network inadequacy that forces patients out of network.
What you can do.
Help inform patients about their rights under mental health parity laws. Post RIParity posters and materials in your office and share the web-site at www.riparity.org. To order posters and materials, visit: PAGE COMING SOON
Support your patient in filing parity claims and appeals: Understanding the appeals process for health insurance coverage and supporting your patient in accessing the coverage they need is critical to achieving parity.
- Let your patient know they have a right to appeal an insurance denial or unreasonable restriction. Encourage them that, on average, 50% of denied claims get covered when a patient appeals.
- Refer them to the RI Health Insurance Consumer Hotline at 401-270-0101 (housed at the RI Parent Information Network) to make sure they have the information and help they need to appeal.
- Support your patient with a clear, detailed, and specific letter of Medical Necessity that includes references to published third party material (i.e. LOCUS) and/or to the patient’s medical record. Click the links below for resources and examples.
RIPIN APPEAL WRITING GUIDE
- Invoke the parity law. If you believe a denial does not comply with the parity law, raise this concern in the appeal. Click the links below for a list of common parity violations.
DON’T DENY ME INFOGRAPHIC
Document and report systemic disparities in coverage and access: Professionals can also have an impact by tracking and reporting systemic barriers to parity that they experience in their practice. Nonquantative treatment limitations have been used to tailor networks, provider payment levels, management protocols, drug formularies, and other policies to attract profitable enrollees and deter those for whom revenues fall short of costs.
- Understand common parity violations.
KNOW YOUR RIGHTS: COMMON VIOLATIONS
DON’T DENY ME INFOGRAPHIC
- Keep a simple ‘log’ to help document – over time – ongoing or systemic insurance denials or unreasonable limitations by type and by plan and report it to the Office of Health Insurance Commissioner. If appropriate and necessary, file a formal complaint.
- Engage with other professionals in legislative and administrative advocacy to improve, strengthen, and expand parity. Click for more information on other professional associations doing advocacy.