Parity FAQ for Addiction and Mental Health Consumers

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California Parity Resources

Depending on whether you are filing a complaint or appeal, the contact information below should be able to help you if you have any questions.

 

Consumer Advocates


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 California.

Health Plan Contacts


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 California Health Plans:

Anthem Blue Cross

Call customer service listed on the back of your membership card.
Submit a grievance form online
Send the form to:
Grievance and Appeals
PO Box 4310
Woodland Hills, CA 91365-4310

 

Blue Shield of California

Call member services
Appeals and grievances forms are here
Mail or fax appeal or grievance forms to:
Blue Shield of California Medicare Appeals & Grievances
PO Box 927
Woodland Hills, CA 91365-9856

 

Chinese Community Health Plans (CCHP)

Call member services: 888-775-7888
Click here for online grievance form and information

 

Health Net

Call customer service
Mail or fax appeal or grievance forms to:
Health Net Appeals and Grievances Department
PO Box 10344
Van Nuys, CA 91410-0344
Fax: (877) 713-6189
Submit online, click here

 

Kaiser Permanente of CA

Northern California
(800) 443-0815
Southern California
(800)556-7677

Complaint form available online, click here

 

L.A. Care Health Plan

Write, visit or call if you have complaints:
Member Services Department
1055 W. 7th street, 10th Floor
Los Angeles, CA 90017
888-839-9909
Click here for online grievance form
 

Oscar Health Plan of California

Grievance form click here
Mail to:
Oscar Health Plan of California
Attention Grievances
PO Box 278
New York, NY 10013
(800) 735-2929

 

Sharp Health Plan

Sharp Health Plan
Grievances and Appeals
8520 Tech Way, Suite 200
San Diego, CA 92123
Fax: (619) 740-8572

File online click here

 

United Healthcare

Call HMO member services 800-624-8822

Call PPO member services 866-414-1959
 

Valley Health Plan

If you have a grievance call member services first: 888-421-8444 and use the Plan’s grievance process before contacting the Department of Managed Health Care (DMHC).
 

Western Health Advantage

Contact member services
File online or download form here

 

State Regulators


Department of Managed Health Care

980 9th Street, Suite 500
Sacramento, CA 95814-2725
(888) 466-2219
Fax: (916) 255-5241
Click here for online assistance

Insurance Commissioner

California Department of Insurance
Insurance Commissioner
300 South Spring Street, South Tower
Los Angeles, CA 90013
(800) 927-4357
www.insurance.ca.gov

 

Utilization Management

Department of Managed Health Care
Deputy Director
Department of Managed Health Care
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
Phone: (916) 255-2405
Fax: (916) 255-5241

 

External Review

Department of Managed Health Care
Deputy Director
Department of Managed Health Care
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
Phone: (916) 255-2405
Fax: (916) 255-5241

 

Parity Appeals

Department of Managed Health Care
Director
980 Ninth Street, Suite 500
Sacramento, CA 95814
(916) 322-2078

 

Additional California Insurance Administration Contacts, click here

 

Federal Regulators


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

 

Veteran and Military Resources


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.

Questions


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