Parity FAQ for Addiction and Mental Health Consumers

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Michigan 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 Michigan.

Attorney General
Health Care (Hospices, Hospitals, Surgical Outpatient Facilities, and Substance Use Disorder Programs)
Complaints DIFS-Office of General Counsel-Appeals Section
PO Box 30220
Lansing, MI 7720
(877) 999-6442

 

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 Michigan Health Plans:

Alliance Health

HAP Senior Plus: (313) 664-7015
Alliance Medicare PPO: (888) 658-2536
By Mail:
Health Alliance Plan
ATTN: Appeal and Grievance Department
2850 W Grand Blvd
Detroit, MI 48202
Fax: (313) 664-5866

Blue Cross Blue Shield of Michigan

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

Member Appeal Form found here
Blue Cross Blue Shield of Michigan
600 E Lafayette Blvd, M.C. CS3A
Detroit, MI 48226-2998

Harbor Health Plan

Written request for a hearing:
Michigan Administrative Hearings System for the Department of Community Health
PO Box 30763
Lansing, MI 48909
(877) 833-0870

Humana

Contact Customer Service at number found on back of ID card

The Grievance/Appeal Request Form can be found here
Mail to:
Humana Grievances and Appeals
PO Box 14165
Lexington, KY 40512-4165

McLaren Health Plan Community

Customer Service: (888) 327-0671

Mail written appeal request to:
McLaren Health Plan
G-3245 Beecher Rd
Flint, MI 48532
Attn: Member Appeals

Meridian Health Plan

Member Services department: (877) 902-6784

 

Physicians Health Plan

Customer Service Department: (800) 832-9186

Priority Health

Customer Service: the number is specific to the health plan

Total Health Care USA

Customer Service Department: (313) 871-2000 or (800) 826-2862

United Healthcare

Contact the Member Service number found on the back of member ID card

 

 

State Regulators


 

Insurance Commissioner

Department of Insurance and Financial Services
Director
611 W. Ottawa Street, 3rd Floor
Lansing, MI 48933
Phone: (517) 241-2349
Fax: (517) 241-4610

 

Utilization Management Appeals

Department of Insurance and Financial Services
Manager
611 W. Ottawa Street, 3rd Floor
Lansing, MI 48933
Phone: (517) 241-2349
Fax: (517) 241-4610

 

External Review Appeals

Department of Insurance and Financial Services (DIFS)
Regulation Specialist
611 W. Ottawa Street, 3rd Floor
Lansing, MI 48933
Phone: (517) 373-2898
www.mighigan.gov/difs

 

Parity Appeals

Department of Insurance and Financial Services
Manager
611 W. Ottawa Street, 3rd Floor
Lansing, MI 48933
Phone: (517) 241-2349
Fax: (517) 241-4610

Additional Michigan 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