Virginia 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 Virginia. 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 Virginia Health Plans:

Aetna

Call Member Service on the member ID card Member Complaint and Appeal Form found here Mail request to: Aetna PO Box 14463 Lexington, KY 40512

Health Keepers (Anthem)

Call Member Services: 855-817-5787 Complaints, appeals and grievances can be written and sent to: Complaints, Appeals and Grievances HealthKeepers, Inc PO Box 61116 Virginia Beach, VA 23466-1599

CareFirst BlueCross BlueShield

Call the Member Services number on the member ID card Written complaints and appeals can be sent to the address on the member ID card

Coventry

Call the Customer Service number on the ID card Written complaints or grievances send to: Southern Health Services, Inc Attention: Customer Service Department PO Box 7135 London, KY 40742 Written appeals send to: Southern Health Services, Inc Attention: Appeal Coordinator 9881 Mayland Drive Richmond, VA 23233

Innovation Health Insurance

Call the Member Service number on the member ID card Member complaint and appeal form

Kaiser Mid-Atlantic

Call Customer Service: 800-777-7902 Written communications send to: Kaiser Permanente Member Services Correspondence Unit 2101 East Jefferson Street Rockville, MD 20852

Optima Health Plan

Contact Member Services at the number listed on the ID card or if no ID card call 877-552-7401 Complaints, Coverage Decisions and Appeals Process To submit an appeal send to: Optima Health Appeals Department PO Box 62876 Virginia Beach, VA 23466-2876

Piedmont Community Healthcare

For medical grievances and appeals call: 434-947-3671 or 877-210-1719 A grievance or appeal may be submitted in writing here: Piedmont Medicare Advantage Grievances/Appeals Dept 1937 Thompson Drive Lynchburg, VA 24501

United Healthcare

Call the Member Service number on the member ID card

Insurance Commissioner

Virginia State Corporation Commission, Bureau of Insurance Commissioner Mailing: P.O. Box 1157 Richmond, VA 23218 Physical Address: 1300 East Main Street Richmond, VA 23219 Toll Free: (800) 552-7945 Phone: (804) 371-9741 Fax: (804) 371-9873 bureauofinsurance@scc.virginia.gov

Utilization Management Appeals

Virginia Department of Health, Office of Licensure and Certification Director 9960 Maryland Drive, Suite 401 Richmond, VA 23233-1485 Phone: (804) 367-2102 Fax: (804) 367-2149 inquiries@vdh.virginia.gov

External Review Appeals

Virginia Bureau of Insurance, External Review Manager Tyler Building 1300 E. Main Street Richmond, VA 23219 Phone: (804) 371-9913

Parity Appeals

Virginia Department of Health, Office of Licensure and Certification Director 9960 Maryland Drive, Suite 401 Richmond, VA 23233-1485 Phone: (804) 367-2102 Fax: (804) 367-2149   Additional Virginia 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