Parity FAQ for Addiction and Mental Health Consumers

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Missouri 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 Missouri.

Leading Age Missouri: Advocacy for Consumers
http://www.leadingagemissouri.org/?page=ConsumerAdvocacy

 

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 Missouri Health Plans:

Anthem Blue Cross Blue Shield/Healthy Alliance Life Insurance Company/HMO Missouri

Call Customer Service number listed on the member ID card

Mail written appeal requests or grievances to:
Anthem
Attn: Grievance/Appeal
PO Box 105568
Atlanta, GA 30348

Blue Cross Blue Shield of Kansas City

Customer Service: (888) 989-8842 or (816) 395-3558

Attn: Grievance/Appeal
One Pershing Square
2301 Main
Kansas City, MO 64108

Cigna

Call Member Services at the number on the member ID card

Submit appeals to:
Cigna Healthcare Inc. National Appeals Unit (NAO)
PO Box 188011
Chattanooga, TN 37422

If the ID card includes the “GWH-Cigna” or “G” indicators, please submit to:
Great-West Healthcare
P.O. Box 188062
Chattanooga TN 37422-8062

Coventry

Customer Service: (800) 755-3901

Submit written appeal to:
Coventry Health Care
Appeals Department
550 Maryville Centre Drive, Suite 300
St. Louis, MO 63141-5818

Humana

Contact Customer Service at number found on back of ID card

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

United Healthcare

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

 

State Regulators


 

Insurance Commissioner

Missouri Department of Insurance
Director
301 West High Street, P.O. Box 690
Jefferson City, MO 65102
Phone: (573) 751-4126
Fax: (573) 751-1165

 

Utilization Management Appeals

Missouri Department of Insurance, Financial Institutions & Professional Registration; Insurance Market Regulation Division, Life and Healthcare Section
Life and Health Manager
301 West High Street, P.O. Box 690
Jefferson City, MO 65102
Phone: (573) 751-2430
Fax: (573) 751-1165

 

External Review Appeals

Missouri Department of Insurance, Financial Institutions and Professional Registrations
Life and Health Consumer Services Manager
301 West High Street, P.O. Box 690
Jefferson City, MO 65102
Phone: (573) 526-0601

 

Parity Appeals

Missouri Department of Insurance
Director, Missouri Department of Insurance, Financial Institutions & Professional Registration
301 West High Street, P.O. Box 690
Jefferson City, MO 65102
Phone: (573) 751-243

Additional Missouri 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