Parity FAQ for Addiction and Mental Health Consumers

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Nevada 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 Nevada.

Office of Consumer Health Assistance Governor’s Consumer Health Advocate
555 East Washington Ave #4800
Las Vegas, NV 89101
(888) 333-1597 or (702) 486-3587
http://dhhs.nv.gov/Programs/CHA/

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 Nevada Health Plans:

Aetna

Call Customer Service

Appeal Form found here
Mail form to:
Aetna
PO Box 14463
Lexington, KY 40512

Anthem

Contact Customer Service at the number listed on the member ID card.

Celtic

Customer Service: (800) 477-7870

Coventry

Customer Service: (855) 449-2889

Written appeal request submitted to:
Coventry Health Care
Appeals and Grievance Department
10421 South Jordan Gateway, #400
South Jordan, UT 84095

Health Plan of Nevada

Call Member Services: (800) 777-1840

Submit written appeal request to:
Health Plan of Nevada
Attn: Claims Research
PO Box 15645
Las Vegas, NV 89114-5645

Hometown

Customer Service: (775) 982-3112

For Medicare Complaint Form click here

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

Prominence

Call Member Services:
HMO/POS Members: (800) 863-7515
PPO Members: (800) 433-3077
Exchange Members: (844) 238-2292

Sierra Health and Life

Member Services: (702) 242-7700 or (800) 888-2264

Written requests to:
Member Services
Sierra Health and Life
PO Box 15645
Las Vegas, NV 89114-5645

United Healthcare

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

 

State Regulators


Insurance Commissioner

Nevada Department of Business and Industry, Division of Insurance
1818 E. College Parkway, Suite 103
Carson City, NV 89706
Phone: (775) 687-0700
Fax: (775) 687-0787

Utilization Management Appeals

Nevada Department of Business and Industry, Division of Insurance
1818 E. College Parkway, Suite 103
Carson City, NV 89706
Phone: (775) 687-0700
Fax: (775) 687-0787

External Review Appeals

Nevada Department of Insurance
1818 E. College Parkway, Suite 103
Carson City, NV 89706
Phone: (707) 486-3586

Parity Appeals

Nevada Department of Business and Industry, Division of Insurance
1818 E. College Parkway, Suite 103
Carson City, NV 89706
Phone: (775) 687-0700
Fax: (775) 687-0787

 

Additional Nevada 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