Avalon Hills is very passionate about those that we treat gaining access to their insurance benefits for their individual policies. Unfortunately, all too often insurance denials are common and families find themselves at a loss of what to do. Avalon Hills Treatment Team and Utilization Review and Billing Department work hard to educate our patients on Mental Health Parity and how to access the benefits available on their plans. This takes a lot of hard work by the consumers. Hopefully the following information can help people become better educated about Mental Health Parity and can empower you to understand your individual insurance benefits better.
www.mentalhealthparitywatch.org has been a great resource for us and I encourage families to utilize the information that they provide.
The Parity Act became effective on October 3, 2009, and for most calendar-year plans began January 1, 2010. Basically “Parity” means that as of January 1, 2010 insurance companies must provide mental health benefits equal to other medical and surgical benefits. They must provide the same coverage for diseases like anorexia and bulimia as they do for physical ailments.
Some of the provisions of the new laws will not be phased in until 2014. And, as always when health insurance issues occur in the U.S. there are extenuating circumstances with regard to insurance parity. Avalon Hills knows that to effectively treat our patients we are not only treating eating disorders but we are also working with our patients and their families to access insurance benefits to provide funding for necessary treatment.
Again, we encourage families to review their individual insurance policies or plans and to research information about how parity coverage applies to them. Additionally, you can contact Avalon Hills directly if you have questions on the applicability of these new laws to your situation or that of a friend or loved one. (800) 330-0490
The following information was taken from www.mentalhealthparitywatch.org and may be useful for those that are having trouble understanding or accessing their insurance benefits.
To File Complaints and Grievances
with your State’s insurance consumer complaints division
for an ERISA [self-funded] plan
To Report Plan Violations
You can report plan violations to the Parity Implementation Coalition for review. Please include the following information:
- Name of plan issuer/employer
- Effective date of plan
- Parity Violation
- Date(s) of service
- Health Plan’s Summary of Benefits (please include MH/SUD and Med/Surg)
- Health Plan’s Explanation of Benefits
- Plan written denial provided to consumer or provider
Email your report with all supporting documentation (i.e. denial letter, plan medical necessity criteria, summary of plan benefits for medical/surgical and MH/SUD, etc) to info@mentalhealthparitywatch.org.
If you prefer to use mail delivery send your material to the
Parity Implementation Coalition
101 Constitution Avenue NW, Suite 675E
Washington DC 20001
You can download a copy of a pdf file of the report form to use as a guide.
If you have questions about how or what to submit, either email us at the above email address or call 1.866.882.6227
To Ask Questions/Report Concerns
Email info@mentalhealthparitywatch.org or call to leave a voice mail message (toll free) 866.882.6227. Members of the Parity Implementation Coalition are monitoring compliance with the Mental Health Parity Act.
Include brief statement of problem, your name and contact information (email/phone), health plan’s name, type of health plan (e.g., group health plan, self-funded health plan, etc.), state where insurance is issued, whether company employs 50 or fewer employees. Information provided to us will be held confidential.
Additional Resources
FamiliesUSA Resources on Benefit Denials and Appeals Under ERISA:
- Overview of ERISA Claims Procedure Regulations (includes links to the rules)
- Summary of Main Provisions of Claims and Appeals Procedures
- Glossary of Terms
- Urgent Service Claim Timeline
- Pre-Service Claim Timeline
- Post-Service Claim Timeline
Kaiser Familiy Foundation: A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan, 2005 Update
Final Comments to the IFR from:
- Parity Implementation Coalition 4.30.10
- American Psychiatric Association 5.3.10
- American Psychiatric Association summary of comments 5.3.10
Note: Additional comments submitted on specific issues with the IFR are available through a search on the DOL website.
Federal Parity Guidelines/Interim Final Rule [IFR] with comment period released 1.29.10
The Departments of Health and Human Services, Labor and the Treasury jointly issued interim final regulations [IFR] to provide guidance on how the parity act must be implemented. Comment deadline was May 3, 2010.
