Florida Parity Resources

For general information about filing a parity appeal for mental health or addictions services, you cannot go wrong with contacting one of the consumer advocates below. Each has years of experience helping consumers in the state of Florida. Attorney General For information regarding filing a complaint, click here.

When filing an appeal for the first time, you should contact your health plan’s customer service support line or check out their information online. If you choose to appeal an adverse benefit determination concerning your mental health or substance use treatment or benefits, please keep in mind that the timeframe to do so varies by state, plan type, and other factors. Contact your state’s department of insurance for additional information. Here is some contact information for Florida Health Plans:

Aetna

Click here for the complaint and appeal form Aetna PO Box 14463 Lexington, KY 40512 Fax: (859) 425-3379

Celtic

Customer Service: 800-477-7870

Coventry Health Care of Florida

Customer Service: 866-847-8235

Florida Blue

Blue Cross and Blue Shield of Florida 4800 Deerwood Campus Parkway Jacksonville, FL 32246 Customer support: 904-905-0000 Submit a complaint online.

Health First Commercial

Customer service: General information & Medicare Advantage: 800-716-7737 Individual & Group: 855-443-4735 or Sign up online to access information concerning your account.

Molina Healthcare

Member Services: (866) 472-4585 Member Grievance/Appeal Request Form found here Mail to: Molina Healthcare of Florida Attention: Grievance & Appeals Department PO Box 521838 Miami, FL 33152 Fax: (877) 508-5748

United Healthcare Life

Medicare Advantage Plans Contact Customer Service at the telephone number listed in the Summary of Benefits  

Insurance Commissioner

Florida Office of Insurance Regulation Kevin M. McCarty, Commissioner The Larson Building 200 E. Gaines Street, Room 101A Tallahassee, FL 32399 Phone: (850) 413-5914 Fax: (850) 488-3334

Utilization Management Appeals

Florida Agency for Health Care Administration, Hospital & Outpatient Services Unit Laurel MacLafferty, Chief 2727 Mahan Drive, MS #31 Tallahassee, FL 32308 Phone: (850) 412-4340 Fax: (850) 413-7955

External Review Appeals

Florida Agency for Health Care Administration, Hospital & Outpatient Services Unit Jack Plagge 2727 Mahan Drive, MS #31 Tallahassee, FL 32308 Phone: (850) 412-4358 Fax: (850) 413-7955

Parity Appeals

Florida Agency for Health Care Administration Ruby Schmigel, Regulatory Specialist 2727 Mahan Drive, MS #31 Tallahassee, FL 32308 Phone: (850) 487-2717   Additional Florida Insurance Administration Contacts, click here.  

The federal government also can be a helpful resource if you are enrolled in a self-funded plan, Medicare, Medicaid or another type of insurance that is overseen at least in part by a federal agency.

For definitions and filing information refer to the Parity Resource Guide

U.S. Department of Health and Human Service’s website on the Affordable Care Act health reform law

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA)

(SAMHSA) Implementation Mental Health Parity Addiction Equity Act

U.S. Centers for Medicare and Medicaid Services (CMS)

U.S. Department of Labor, Employee Benefits, Security Administration (EBSA) or toll-free hotline: 1.866.444.EBSA (3272)

For the U.S. Department of Health and Human Services & Centers for Medicare and Medicaid Services list of exempt state and local plans, please email NonFed@cms.hhs.gov. You may ask them if any particular state and local plan has opted out of MHPAEA.

Information on requirements of employer-based insurance coverage and self-insured health plans.
EBSA has benefit advisors who are available to answer questions and provide assistance in obtaining your benefits.

Consumer Guide to Disclosure Rights: Making the Most of Your Mental Health and Substance Use Disorder Benefits

Veterans and military personnel can use these resources to get help or more information with their medical or behavioral health complaints.

Health Net Federal Services

A grievance is a written complaint or concern about a medical provider.
Click here for specific information regarding who, what and how to file.

TRICARE

View the recently released Tricare Mental Health Fact Sheet.

The appeal process is different based on the benefit issue. Depending on your issue, you can file a:

• Factual appeal
  • This is if you were denied payment for services or supplies you received, or if payment was stopped for services or supplies previously authorized.
• Medical necessity appeal
  • This is if prior authorization for care or services was denied because it was not deemed medically necessary. Medically necessary means it must be appropriate, reasonable, and adequate for your condition.
• Pharmacy appeal
  • This is if you don’t agree with a decision made about your pharmacy benefit. For example, Express Scripts denies your pharmacy claim.
• Medicare-TRICARE appeal
  • This is if you’re eligible for both TRICARE and Medicare, and Medicare denies your services or supplies.

If your care is denied, you should receive a letter with details about how to file your appeal.

Veterans Health Administration

Complaints are initially handled through the Patient Advocate.
Patient Advocate can be contacted at your local VA Medical Center.

If you have any additional questions about parity compliance, please contact info@paritytrack.org