Parity FAQ for Addiction and Mental Health Consumers

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Florida 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 Florida.

Attorney General
For information regarding filing a complaint, click here.

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 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

Click here for “how to” information
Written Grievances:
CHC of Florida
Attn Grievance & Appeals Dept
1340 Concord Terrace
Sunrise, FL 33323

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

 

State Regulators


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.

 

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