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Best Practices Guide to Improve the Parity Complaint Process
This guide offers best practices to improve the consumer complaint process and parity problem identification and describes state models for each practice. It also includes a model parity complaint form and implementation guidance to help stakeholders adopt the strategies most appropriate for their state. |
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Consumer Health Insurance Knowledge and Experience Survey: Report of FindingsThis report details the findings of a survey conducted by Public Health Management Corporation in five states (Illinois, Maryland, New Jersey, New York and Ohio) to better understand consumers’ experiences related to accessing mental health and substance use services and their understanding of the Parity Act. |
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Provider Parity Act Knowledge and Practice Survey: Report of FindingsThis report details the findings of a survey conducted by Public Health Management Corporation in five states (Illinois, Maryland, New Jersey, New York and Ohio) to better understand providers’ experiences related to addressing patients’ access to mental health and substance use services as well as provider understanding of the Parity Act. |
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Mental Health and Substance Use Disorder Denial Tracker for ProvidersThis tool is designed to help providers track problems their patients face in getting their health insurance plans to cover mental health or substance use disorder (MH/SUD) treatment services. |
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Help Patients Respond to Insurance BarriersTips for treatment providers on helping patients when insurers deny or limit their mental health or substance use disorder treatment. |
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Your Insurance RightsFive tips to help you understand your mental health and substance use disorder treatment rights. |
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Parity Warning SignsThree parity warning signs to help you determine if your insurance company is violating your right to equal mental health and substance use disorder treatment. |
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State Attorney General Parity Act Enforcement ToolkitThis Toolkit has been created specifically for State AGs to promote an understanding of the Parity Act and provide specific actionable steps to achieve parity’s full promise through active enforcement. |
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Consumer Inquiry and Response Center (CIRC)Obtain answers to any questions or open formal complaints through multiple outreach channels through the state of New Jersey’s Department of Banking and Insurance. |
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Parity Implementation CoalitionObtain resources and information designed to help you communicate with plans, address disputes and better understand basic appeals rights and procedures. |
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What You Need To Know About Mental Health CoverageAddresses a variety of parity topics through a question and answer format. |
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External reviewProvides a brief step-by-step section on filing an external review. Describes when a consumer can file an external review, consumer rights related to external review, where to look for additional information about external review, length of time, cost, and assistance available in filing external appeal. |
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How To File An Internal AppealProvides a brief step-by-step section on filing an internal appeal through your insurance provider. Also includes FAQs covering topics such as necessary documentation; when consumers can file appeals; length of the review process; and expedited appeals. |
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Warning Signs: Plan or Policy Non-Quantitative Treatment Limitations (NQTLs) that Require Additional Analysis to Determine Mental Health Parity ComplianceProvides a number of examples to illustrate different treatment limits. |
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Red Flags! Your Health Plan May Be Violating The LawLearn how to identify parity violations when it comes to your health insuance plan and their coverage of substance use disorder and mental health care. |
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File a Consumer ComplaintProvides an opportunity to file a complaint directly with a state’s insurance department. |
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Model State Parity LegislationExplore model legislation that targets critical areas that must be addressed to ensure that coverage for mental health conditions and substance use disorders is equal to coverage for other medical conditions. |
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Parity TrackTrack legislative, regulatory, and legal parity activities in all 50 states and at the Federal level to monitor implementation and best practices. |
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Parity Partner ToolkitA toolkit containing downloadable resources to help promote the use of Parity Registry and Parity Track. |
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Parity RegistryA website where consumers can learn to file an appeal with their health plan after being wrongfully denied coverage for mental health or addiction treatment services. |
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Advocacy and Health Insurance Coverage Template LanguageTemplate language for individuals who are advocating for better coverage of substance use and mental health services in their health insurance plan. |
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Parity InfographicsSix downloadable infographics that include impactful statements, facts and figures for use on social media channels. |
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Mental Health and Substance Use Disorder Denial Tracker for Providers in New JerseyThis tool is designed to help providers track problems their patients face in getting their health insurance plans to cover mental health or substance use disorder (MH/SUD) treatment services in the state of New Jersey specifically. |
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Ohio ToolkitThis toolkit includes information on basic insurance rights, parity violation warning signs, and how to file an appeal with Medicaid as well as private insurers in Ohio. |
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New York ToolkitThis toolkit includes information on basic insurance rights, parity violation warning signs, and how to file an appeal with Medicaid as well as private insurers in New York. |
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New Jersey ToolkitThis toolkit includes information on basic insurance rights, parity violation warning signs, and how to file an appeal with Medicaid as well as private insurers in New Jersey. |
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Illinois ToolkitThis toolkit includes information on basic insurance rights, parity violation warning signs, and how to file an appeal with Medicaid as well as private insurers in Illinois. |
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Maryland ToolkitThis toolkit includes information on basic insurance rights, parity violation warning signs, and how to file an appeal with Medicaid as well as private insurers in Maryland. |
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Insurance Navigation SeminarsAttend in-person meetings to understanding what’s covered, how to optimize out-of-pocket cost savings, and how to fight back if coverage is denied for treatment. |
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Your Insurance Questions AnsweredUtilize insurance specialists to help you navigate the insurance landscape and answer questions about private insurance, Medicaid and Medicare coverage. |
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Maryland Office of the Attorney General, Health Education and Advocacy UnitResource for mediation services to Maryland consumers who have a billing dispute with their healthcare provider or a coverage dispute with their HMO or health insurance company |
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Maryland Insurance Administration Consumer Appeals/Grievance InformationOverview of the process for filing a consumer appeal/grievance with the Maryland Insurance Administration. |
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New York Attorney General: General Health Care Complaint Form (Online and Printable)General Health Care Complaint form for the New York State Attorney General’s Office. |
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New York Department of HealthInformation and resources regarding filing a complaint against a managed care plan in New York State. |
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New York State Department of Financial Services Consumer Complaint InformationOverview of the process for filing a consumer complaint with the New York State Department of Financial Services |
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New Jersey Department of Banking and Insurance Managed Care Plan Complaint FormComplaint form for persons covered under a managed care plan in New Jersey. |
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New Jersey Department of Banking and Insurance Managed Care Plan Complaint InformationOverview of the process for filing a consumer complaint for a person covered under a managed care plan in New Jersey. |
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New Jersey Department of Banking and Insurance Consumer Complaint FormConsumer complaint form for the New Jersey Department of Banking and Insurance. |
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CareSource (OH Medicaid) Grievance/Appeal InformationOverview of covered person’s rights related to the CareSource (OH Medicaid) grievance/appeal process. |
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CareSource (OH Medicaid) Grievance/Appeal FormComplaint form for persons covered under CareSource (OH Medicaid). |
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Ohio DOI Consumer Complaint FormConsumer complaint form for the Ohio Department of Insurance. |
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Ohio DOI Consumer Complaint InformationOverview of the process for filing a consumer complaint with the Ohio Department of Insurance. |
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Office of the Attorney General for the State of Illinois: Getting Help with Mental Health and Substance Use Disorder Claim DenialsInformation regarding red flags for potential parity law violations and resources for filing a complaint with the Illinois Attorney General’s Health Care Bureau. |
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Illinois Department of Healthcare and Family ServicesInformation regarding filing a complaint with the Illinois Department of Healthcare and Family Services. |
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Illinois Department of Insurance Consumer Complaint InformationOverview of the process for filng a consumer complaint with the Illinois Department fo Insurance. |
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Illinois Department of Insurance Consumer Complaint FormConsumer complaint form for the Illinois Department of Insurance. |
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Illinois Attorney General Health Care BureauResources to help consumers with difficulties they encounter in obtaining health care services and insurance benefits through mediation, investigation and enforcement actions. |
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Illinois Insurance FactsInformation about mental health and substance use disorder insurance coverage from the Illinois Department of Insurance. |
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Working Group Regarding Treatment Coverage of Substance Abuse Disorders and Mental Illness Annual ReportA list of the health care insurance carriers, mental health advocacy groups, substance abuse patient advocacy groups, and mental health physician groups, details on the issues and topics covered, and legislative recommendations as required by statute. |
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Mental Health and Substance Use Disorder Parity: What Consumers and Providers Need to KnowAn overview of key insurance terms and where to get help. |
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Baltimore City Crisis Information and Referral LineBaltimore City CIR: Mental health and Substance Use Disorder crisis support and treatment referral hotline from the Baltimore City Health Department for those in Baltimore City, MD. |
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Maryland Health Connection – “Choosing a Health Plan: Substance Use Disorder Treatment”Information regarding Substance Use Disorder treatment coverage for consumers purchasing health plans through the Maryland Health Connection. |
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Maryland Department of Health, BH Administration – SUD Treatment Services LocatorDatabase of state-certified Substance Use Disorder treatment programs in Maryland. |
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MD Dept. of Health, BH Administration – “Before it’s too Late” Crisis HotlineBefore it’s too Late Crisis Hotline: Crisis support and treatment locator for mental health and Substance Use Disorder services from the Maryland Department of Health, Behavioral Health Administration. |
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OH Dept. of Mental Health and Addiction Services Crisis Text LineOhioMHAS website and “4Hope” Crisis Text Line: Crisis support and treatment resources for mental health and Substance Use Disorder services in Ohio. |
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IL Dept. of Health and Human Services MH Treatment Locator ResourcesCrisis support and treatment locator for mental health services from the Illinois Department of Health and Human Services. |
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IL Dept. of Health and Human Services SUD Treatment Locator ResourcesIllinois Helpline for Opioids and Other Substances: Resource for finding Substance Use Disorder services from the Illinois Department of Health and Human Services. |
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Addiction Open Access 24/7 HotlineHotline for individuals with SUD & their families in Western NY. |
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“Got5” Crisis Text LineOMH Website and “Got5” Crisis Text Line: Mental health crisis support and treatment resources from the NYS Office of Mental Health. |
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HOPE-NY HotlineHOPE-NY Hotline: Information and referrals for SUD from NYS Office of Alcoholism & Substance Abuse Services. |
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NYS Office of Alcoholism & Substance Abuse Services Treatment Availability DashboardResource to search for state certified outpatient or bedded programs in New York. |
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Accessing Insurance Coverage For Substance Use and Mental Health Treatment Training VideoRecorded webinar explaining parity and related laws. |
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New York Attorney General’s Parity Enforcement ResourcesA summary of the New York Attorney General’s settlements finding parity violations. |
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New Jersey Dept. of Health, Division of Mental Health and Addiction Services Treatment Locator ResourcesTreatment locator for MH/SUD services from the State of New Jersey Department of Health. |
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Consumer Toolkit for Navigating Behavioral Health and SUD Care Through Your Health Insurance PlanIncludes things like a glossary of terms and a checklist of the best things to ask your health insurer and your doctor so your health plan pays for the appropriate care. |
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Consumer Guide to Understanding Your Health Insurance Coverage for Mental Health and SUDsA toolkit to help MD residents better understand insurance coverage for mental health and substance use disorders. |
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Mental Health and SUD Coverage FAQProvides general information and guidance about insurance coverages and laws in Illinois. |
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Illinois Department of Insurance Jennifer Hammer Answers Questions on Mental Health ParityThis video addresses parity, substance abuse treatment and how to get assistance if you believe your insurance company has unfairly denied you coverage. |
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Understanding Your Mental Health and Substance Use Disorder Benefits – InfographicHelps consumers in Ohio understand the Parity Law and steps to take to see if you have coverage. |
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Parity Guide Sample LettersProvides sample letters for appeals and requests for documents. |
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Has Your Health Insurer Delayed or Denied Substance Use Or Mental Health Care? They May Be Breaking the Law!Explains the appeal process to challenge insurance denials and adverse decisions in NY. |
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Health Insurance for Addiction & Mental Health Care: A Guide to the Federal Parity LawAn overview of the federal parity law; information on how to identify what type of health insurance plan you have; actionable steps and support resources, including sample complaint letters if you believe your plan is violating the law. |
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Issue Brief: IL Providers Report Barriers to Mental Health and Addiction CoverageAn overview of the barriers Illinois providers and patients face while seeking treatment for mental health and addiction coverage. |