Equal Insurance Coverage Of Substance Use and Mental Health Disorders. It's The Law.

The Problem

Consumers are often forced to fight for the health care they need and are entitled by law to receive. A recent analysis found that most insurance plan documents failed to provide the information consumers need to determine whether their coverage complies with the Parity Act.

The Solution

Parity at 10 seeks to eliminate discriminatory insurance coverage for those with mental health and substance use disorders so that millions of people can get the care they need.

“We need to move from a system that relies on people in the middle of personal turmoil to identify wrongdoing … to one that is grounded in proactive enforcement of the law.”

PATRICK J. KENNEDY, FOUNDER OF THE KENNEDY FORUM

Parity at 10 will call on state regulators to ensure that plans are complying with the law before they are sold. The three-year campaign will establish effective models for robust enforcement.

About the Law

The Parity Act requires equitable coverage of substance use disorder (SUD) and mental health (MH) benefits in both the public and private health insurance markets.

Plans covered by the federal Parity Law, which was passed in 2008, cannot apply more restrictive financial requirements or treatment limitations to MH and SUD benefits compared to other medical/surgical benefits covered by the plan.

  • Financial requirements include co-pays, deductibles, co-insurance, and other out-of-pocket costs.
  • Treatment limitations include both quantitative (number or frequency of visits) and non-quantitative (medical management tools) limitations.

The federal Parity Law applies to most insurers, including:

  • Large group health plans
  • Plans in the individual and small group markets
  • Medicaid managed care plans that offer coverage for MH and/or SUD benefits
  • Coverage provided through the Children’s Health Insurance Program (CHIP)
  • Medicaid Alternative Benefit Plans (ABPs), including those provided to the Medicaid expansion population

Full implementation of the Parity Law would end discriminatory insurance coverage for those with mental health and substance use disorders. But that will only happen with vigorous enforcement of the law.

Facts and Figures

  • Substance use disorders are a leading cause of death in the United States.
  • Every day, more than 290 Americans die from a drug overdose or suicide.
  • Drug overdose is the leading cause of death for Americans under 50 years of age.
  • 21.5 million Americans need SUD care, but only 2.3 million actually receive it according to government data.
  • Since enactment of the Parity Act, addiction and mental health treatment numbers have not increased significantly, even in the face of the worst opioid epidemic in our nation’s history.

For too many Americans, treatment is still inaccessible – even for those with insurance coverage. The Parity Law cannot achieve its promise without vigorous enforcement.

IMPACT STORIES

Share your story

The Mental Health Parity and Addiction Equity Act (Parity Act) was enacted a decade ago to prevent discriminatory insurance coverage for mental health and substance use disorder services. Today, too many people still cannot get the treatment they need because their insurer still uses discriminatory rules. Better enforcement of the Parity Act can help you and others get the services that insurers are required to cover. By sharing your experience with insurance problems, you can help us advocate for better enforcement of the Parity Act and improved access to treatment.

Here are some of the insurance problems you may have experienced:

  • Your insurer said a treatment service was not “medically necessary.”
  • Your insurer required you to get prior approval for a service that delayed treatment.
  • Your insurer told you to try a less expensive service or medication before it approved the service or medication your provider recommended.
  • You could not find a treatment provider in your insurer’s network.

Privacy Policy

Your story:

Please share your experience with insurance delay or denials using the text boxes below. We have identified a few questions to guide your response, but you should feel welcome to share whatever you think is important. Your experience will help to inform our advocacy work, and we thank you for taking the time to share it!

Who were you seeking treatment for (yourself, son, daughter, spouse, other family member, or friend) and was that person a minor or an adult at the time?

What treatment services did you seek coverage for?

Identify any problems you had finding a treatment provider or getting into care quickly.

Describe your experience in getting your insurer to approve or pay for your treatment services.

If you had problems with your insurance coverage, please describe the impact on you or your family (financial situation, health of the person needing treatment and other family members, personal or family stress).

How are you and/or your loved one is doing today?

Is there anything else about your experience that you’d like to share?

Scope of Use:

Thank you for sharing your story. Your story matters and can help to change the system. The following details are important.

Please let us know how you would like to be identified:


My first and last nameMy first name onlyA pseudonym/remain anonymous


I consent to Parity at 10 utilizing my story in the following way(s): On the Parity at 10 website (www.parityat10.org)

  • In social media messages pertaining to the Parity at 10 Campaign
    and/or
  • In printed materials produced by the Parity at 10 Campaign to educate policy-makers, healthcare providers and other families/consumers


I consent to Parity at 10 utilizing the following photographs, videos, or other media (I may be identified in relation to this media in the manner I indicated above):

We would like to stay in touch with you as there may be additional opportunities to share your story beyond the previously mentioned outlets. Please let us know what interests you. (Check all that apply)

I am interested in participating in meeting with state policy-makers about my insurance experience. Experience

I would consider speaking to the media about my experience (note, we will contact you to present the media opportunity and to affirm your willingness prior to connecting you with the journalist).

Parity at 10 may contact me if they seek to use my story in an additional way not indicated above.

Permission:

I hereby give permission for the Parity at 10 Campaign to use, publish, and condense the testimonial and/or media uploaded I have provided. I hereby release, discharge, and agree to hold harmless the Parity at 10 campaign from any liability relating to the publication of my testimonial except if it is used in a way that is inconsistent with what is outlined above.

Typing your name above indicates that you have read and understand this consent form, have been given all of the information needed related to sharing my your story, and that you agree to everything explained herein.

[FOR MINORS ONLY] If you are under 18 years of age, your parent or legal guardian must sign
this Consent and Release Form and provide the information requested below.

I certify that I am the parent or legal guardian of the person listed above and I agree that I have read this form completely and I understand the contents of this form.