Mental Health Parity

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires insurance companies to cover mental, behavioral, and substance use care equal to/in the same way as physical health care. For example, under this law, if an insurance plan pays 80% of the cost of seeing a clinician within their insurance network, then by law it wouldn’t matter if that provider was a PCP, an ear-nose-and-throat doctor, or a psychiatrist. The Mental Health & Autism Insurance Project works to explain the MHPAEA and ensure that this law is enforced.

Do all insurance plans have to follow the MHPAEA?

There are still some insurance plans that are not required to follow the mental health parity law. These include:

• Medicare

• U.S. Department of Defense/Tri-Care

• some Medicaid plans (fee-for-service plans)

• some non-federal government plans

• some workplace plans that have fewer than 50 employees

• plans that have been active since before March 2010.

The National Alliance on Mental Illness (NAMI) has information on mental health parity. This includes a list of benefits and services that must be covered equally. For autism, there are also state-by-state mandates.

Recognizing disparities in mental health coverage

Even though the law requires the same level of coverage for mental and behavioral health and physical health care, it’s clear from the list above that many plans aren’t required to cover mental health, while other plans have been effectively avoiding it or under-covering it. For more information on specific coverage, consult People with Medicaid coverage can use this interactive map with contact information for the Medicaid Director in each state.

ParityTrack is an organization that follows mental health parity compliance state by state. It provides information on laws passed in each state and how they affect the mental health services delivered. For example, a 2018 Iowa law requires insurance companies to cover telehealth visits.

The U.S. Department of Labor (USDOL) is responsible for ensuring that insurance companies comply with the MHPAEA. The USDOL has advice about mental, behavioral, and substance use benefits, and explains how the organization enforces the mental health parity law.

Read the news release about the Department of Labor’s 2022 report to Congress on insurance companies and mental health parity.

If care is denied, file an appeal

It takes effort to appeal an insurance claim, but if a claim is denied, appealing is one way of petitioning for coverage. When a claim is denied, the written notification will include instructions for filing an appeal and a contact number for questions.

All interaction with the insurance company, including phone calls, needs to be documented in writing. Email is okay as long as it’s clear that any information shared comes directly from the insurer.

If there’s proof an insurance company has broken the law in denying rightful mental or behavioral health care, another way to take action is to report the violation to The Kennedy Forum.

Advocate for enforcement and more for autistic people

Register to be part of the Grassroots Advocacy Network at Autism Speaks. This network works to raise awareness of the needs of people with autism and enforce laws that protect autism care.

Visit the Mental Health America Advocacy Network for a toolkit to improve compliance by contacting state legislators, and more.

For valuable information about appeals, consult the Autism Law Summit’s ABA Authorization and Appeals Playbook.