Parity FAQ for Addiction and Mental Health Consumers

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Iowa 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 Iowa.

Attorney General

Office of the Attorney General of Iowa
Consumer Protection Division
Hoover State Office Building
1305 E. Walnut Street
Des Moines, Iowa 50319-0106
515-281-5926
888-777-4590 (outside of the Des Moines metro area)

Iowa Bureau

(877) 955-1212
http://insuranceca.iowa.gov/health/index.html

 

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 Iowa Health Plans:

Avera Health Plans

Contact Member Services: (888) 322-2115

Coventry

Call Member Services, phone number found on the back of the member ID card or call 800-470-6352

Gundersen Health Plan

Contact Customer Service Representative: (608)  775-8007

Written appeal request to:
Gundersen Health Plan
Member Advocate
1900 Suth Avenue NCA2-01
La Crosse, WI 54601
Fax: (608) 775-8060

Humana

Call member services 800-833-6917

Grievance/Appeal Request Form

United Healthcare of the Midlands

Call Member Services at the number listed on the health plan ID card

Wellmark Blue Cross and Blue Shield of Iowa

Customer Service (800) 524-9242

Appeal form found here.

Mail to:
Wellmark Blue Cross and Blue Shield
Member Appeals, Station 5W189
PO Box 9232
Des Moines, IA 50306-9232

 

State Regulators


Insurance Commissioner

Iowa Department of Commerce, Insurance Division
Commissioner of Insurance
601 Locust Street
Des Moines, IA 50309-3739
Phone: (515) 281-5705
Fax: (515) 281-3059
commissioner@iid.iowa.gov

 

Utilization Management Appeals

Iowa Department of Commerce, Insurance Division
Commissioner of Insurance
601 Locust Street
Des Moines, IA 50309-3739
Phone: (515) 281-5705
Fax: (515) 281-3059
commissioner@iid.iowa.gov

External Review Appeals

Iowa Department of Commerce, Insurance Division
601 Locust Street
Des Moines, IA 50309-3739
Phone: (515) 281-6348
iid.marketregulation@iid.iowa.gov

 

Parity Appeals

Iowa Department of Commerce, Insurance Division
Commissioner of Insurance
601 Locust Street
Des Moines, IA 50309-3739
Phone: (515) 281-5705
Fax: (515) 281-3059
commissioner@iid.iowa.gov

 

Additional Iowa 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