Parity FAQ for Addiction and Mental Health Consumers

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Indiana 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 Indiana.

Office of the Attorney General

For more information 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 Indiana Health Plans:

All Savers

Call Member Services: (800) 291-2634

Anthem Blue Cross Blue Shield

Call the Member Service number listed on the back of the member ID card
(Check the contract or Certificate to determine whether there is a specific process to follow.)

CareSource

Member Services: 844-607-2829

To file a Grievance or Appeal you must complete the HIPAA Authorization Form and send it via fax or mail.

Celtic

Customer Service: (800) 477-7870

Humana

Customer service for individual & family insurance: 800-833-6917

Generally a grievance or appeal can be submitted within 180 days of the date of denial notice but check your plan documents for the exact timeframe.

Humana members can send a completed Grievance/Appeal Request Form; or
Send a letter including name, address, phone number, Humana ID number and the reason for the grievance or appeal to:
Humana Inc.
Grievance and Appeal Department
PO Box 14546
Lexington, KY 40512-4546

(Non-members filing on behalf of a member must fill out an Appointment of Authorized Representative Form.)

IU Health Plan

Membership Services Department: (317) 963-9700 or (800) 455-9776

IU Health Plans, Inc.
Attention: Grievance and Appeals Department
950 N. Meridian Street, Suite 200
Indianapolis, IN 46204

Physicians Health Plan of Northern Indiana

Contact the Customer Service Department: (800) 982-6257 or (260) 432-6690

United Healthcare

Call the number listed on the back of the UnitedHealthcare ID card

 

State Regulators


Insurance Commissioner

Indiana Department of Insurance
311 W. Washington Street, Suite 300
Indianapolis, IN 46204-2787
Phone: (317) 232-2187
Fax: (317) 232-5251

 

Utilization Management Appeals

Indiana Department of Insurance
Director, Indiana LTC Partnership Program, and Manager, UR, IRO, MCR, DMPO Licensing
311 W. Washington Street, Suite 300
Indianapolis, IN 46204-2787
Phone: (317) 232-2187
Fax: (317) 232-5251

 

External Review Appeals

Indiana Department of Insurance
Director, Indiana LTC Partnership Program, and Manager, UR, IRO, MCR, DMPO Licensing
311 W. Washington Street, Suite 300
Indianapolis, IN 46204-2787
Phone: (317) 232-2187
Fax: (317) 232-5251

 

Parity Appeals

Indiana Department of Insurance
Director, Indiana LTC Partnership Program, and Manager, UR, IRO, MCR, DMPO Licensing
311 W. Washington Street, Suite 300
Indianapolis, IN 46204-2787
Phone: (317) 232-2187
Fax: (317) 232-5251
Additional Indiana 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