The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health insurers and group health plans to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical/surgical care.
Getting Help With Denied Mental Health or Substance Abuse Disorder Health Claims
If you believe your health care insurer improperly denied mental health or substance use disorder benefits, you can file a complaint. Where you file the complaint depends on whether you are covered by a health insurance plan issued by a health insurance company, or a by self-insured plan provided by your employer or an association. Starting in January 2022, all insurance cards issued for coverage under a health insurance policy must clearly display "AZDOI" on them. Until then, use the following steps to determine if you are covered under a health insurance policy or under a self-insured plan:
- Self-funded plan ID cards often contain one of the following phrases near the insurer's name: "Administered by," "As administrator for," "Administrative services only," or "ASO." If you have coverage under a self-insured plan, you can request assistance from the US Department of Labor Employment Benefit Security Administration ("EBSA"). Specifically, you can:
- Visit the EBSA "Mental Health and Addition Insurance Help" webpage
- Speak with a trained benefits advisor with the EBSA by calling 866-444-3272
- Submit a request for assistance from the EBSA "Request Assistance from a Benefits Advisor" online form.
- Health insurance plan ID cards may contain the phrase "Underwritten by," or "Insured by" near the insurance company's name.
Categories of Health Insurance Benefits
Health insurance policies provide six classifications of benefits:
- Inpatient, in-network care
- Inpatient, out-of-network care
- Outpatient, in-network care
- Outpatient, out-of-network care
- Emergency care
- Prescription drugs
For a given classification, the MHPAEA prevents insurers from being more restrictive with the number of allowable visits or with maximum allowable costs for mental health treatment than for coverage of medical/surgical care for the same classification of care.