Parity FAQ for Addiction and Mental Health Consumers

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Illinois 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 Illinois.

TOLL-FREE STATE HOTLINE
1 (877) 527-9431

Office of Consumer Health Insurance, Illinois Department of Insurance
Mon-Fri, 8 a.m. to 5 p.m.

You can talk with representatives who will:

  • Explain health insurance coverage for mental health and substance use disorders,
  • Help navigate the mental health parity process, and
  • Assist with appeals and complaints.

You can file a complaint online: https://mc.insurance.illinois.gov/messagecenter.nsf

Health care-specific complaint form is available: http://www.illinoisattorneygeneral.gov/consumers/hcform.pdf

You can send the complaint form to: healthcare@atg.state.il.us

Other contact information:
Springfield Office Main: (217) 782-4515
Chicago Office Main: (312) 814-2420

Additional Information

http://insurance.illinois.gov/HealthInsurance/mental_hlth.asp
http://insurance.illinois.gov/HealthInsurance/MentalHealthFAQs.pdf

 

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 Illinois Health Plans:

Aetna

Call:
1 (800) 624-0756 for HMO-based benefits plans
1 (888) 632-3862 for indemnity and PPO-based benefits plans
Write:
Aetna Provider Resolution Team
PO Box 981106
El Paso, TX 79998-1106
Online:
https://member.aetna.com/MemberPublic/featureRouter/forms?page=commGrievnForm

Blue Cross Blue Shield of Illinois

Call Customer Services:(877) 723-7702

Write:
Blue Cross Community MMAI
Appeals and Grievances
PO Box 27838
Albuquerque, NM 87125-9705
Fax: 1(866) 643-7069

Coventry One

Call Customer Service: 1(800) 431-1211
Written Appeal Requests send to:
Coventry Health Care
Attn: Appeals Department
2110 Fox Drive, Suite A
Champaign, IL 61820-739

Health Alliance

To begin a Review:
Call 800-851-3379

To start an Appeal:
Call: 800-500-3373 or
Mail in writing to:
ATTN: Member Relations
Health Alliance
301 S Vine Street
Urbana, IL 61801

Humana One

Humana Grievances and Appeals
P.O. Box 14165
Lexington, KY 40512–4165
Fax: 1(800) 949–2961
Call: 1(800) 457-4708
Grievance/Appeal Request form here

United HealthOne

Call the Member Service Number on the back of the ID card

 

State Regulators


Insurance Commissioner

Illinois Department of Insurance
Director
320 W. Washington Street
Springfield, IL 62867
Phone: (217) 558-2309
doi.managed.care@illinois.gov

 

Utilization Management Appeals

Illinois Department of Insurance, Utilization Review/Managed Care Compliance Unit
Insurance Analyst
Illinois Department of Financial and Professional Division of Insurance
320 W. Washington Street
Springfield, IL 62767-0001
Phone: (217) 558-2309
Fax: (217) 558-2083
doi.managed.care@illinois.gov

 

External Review Appeals

Illinois Department of Insurance Office of Consumer Health Insurance
320 W. Washington Street
Springfield, IL 62767-001
Phone: (877) 850-4740
doi.externalreview@illinois.gov

 

Parity Appeals

Illinois Department of Insurance
Director
320 W. Washington Street
Springfield, IL 62867
Phone: (217) 558-2309
doi.managed.care@illinois.gov

Additional Illinois Insurance Administration Contacts

Electronic Filing for Insurance Related Issue (both for consumers and providers)

Understanding the Health Care Provider Complaint Process (what must be included in complaint)

Understanding the Consumer Complaint Process (includes email for emailing complaints)

 

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