Parity FAQ for Addiction and Mental Health Consumers

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Maryland 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 Maryland.

Maryland Attorney General Health Education and Advocacy Unit
HEAU Hotline
(410) 528-1840
(877) 261-8007
Mental Health Association of Maryland
Director, Healthcare Reform and Community Engagement
MHAMD
Heaver Plaza
1301 York Road, Suite 505
Lutherville, MD 21093
(443) 901-1550
(800) 572-6426
Fax: (443) 901-0038
info@mhamd.org
www.mhamd.org
Clinical Law Program at Maryland Carey Law
Supervising Attorney
Drug Policy and Public Health Strategies Clinic
University of Maryland Carey School, Clinical Law Program
(410) 706-0590
University of Maryland Francis King Carey School of Law
500 W. Baltimore Street
Baltimore, MD 21201
(410) 706-3295
Fax: (410) 706-5856
The Maryland Parity Project
1301 York Road #505
Lutherville, MD 21093
http://marylandparity.org/
443-901-1550 x206
Attorney General
http://www.oag.state.md.us/consumer/complaint.htm

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 Maryland Health Plans:

Aetna

Call Member Services at the number found on the member ID card.

Form for filing an Appeal, Formal Complaint or Suggestion

CareFirst BlueCross BlueShield

Submit a written appeal to the address that appears on your Member ID card

Cigna

Contact Customer Service at the number located on the back of the member ID card.

Instructions/form to file an appeal request can be found here.

Cigna Appeals Unit
PO Box 188011
Chattanooga, TN 37422

Kaiser Mid-Atlantic

Kaiser Permanente
Member Services Correspondence Unit
2101 East Jefferson Street
Rockville, MD 20852
(301) 468-6000
(800) 777-7902

UnitedHealthcare

High Option Correspondence and Appeals
APWU Health Plan
799 Cromwell Park Drive Suites K-Z
Glen Burnie, MD 21061

Consumer Driven Option Appeals
UnitedHealthcare Appeals
P.O. Box 30573
Salt Lake City, UT 84130-0573

 

State Regulators


The Maryland Insurance Administration is a helpful resource especially if your insurance plan is a “commercial” policy and/or sold through the state exchange, called Maryland Health Connections.

 

Insurance Commissioner

Insurance Commissioner
Maryland Insurance Administration
200 St. Paul Place, Suite 2700
Baltimore, MD 21202
(800) 492-6116
(410) 468-2090
www.mdinsurance.state.md.us

 

Utilization Management Appeals

Chief Investigator
Maryland Insurance Administration
200 St. Paul Place, Suite 2700
Baltimore, MD 21202-2272
(410) 468-2224
www.mdinsurance.state.md.us

 

External Review Appeals

Chief
Maryland Insurance Administration
200 St. Paul Place, Suite 2700
Baltimore, MD 21202
(410) 468-2271
www.mdinsurance.state.md.us

 

Parity Appeals

Maryland Insurance Administration
Life and Health Complaint Unit
410-468-2000
Additional Maryland 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