Parity FAQ for Addiction and Mental Health Consumers

nj

New Jersey 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 New Jersey.

Department of Banking and Insurance
Office of Insurance Claims Ombudsman

Attorney General
New Jersey Division of Consumer Affairs
For information regarding filing a complaint, click here.

Consumer Protection Services
PO Box 329
Trenton, NJ 08625-0329

NJ FamilyCare
Hotline for assistance: 609-588-2655
http://www.state.nj.us/humanservices/dmahs/home/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 New Jersey Health Plans:

Aetna

Contact Member Services at the phone number on the member ID card

Complaint and Appeal form found here
Mail written request to:
Aetna
PO Box 14463
Lexington, KY 40512

AmeriHealth-New Jersey

Customer service: (888) 968-724

CIGNA

Call Members Services at the number listed on the member ID card

Health Republic Insurance of New Jersey

Call: (888) 990-5706

Horizon Blue Cross Blue Shield of New Jersey

Contact member services
File an Appeal/Dispute Form, click here

Request for Redetermination of Medicare Prescription Drug Denial
Click here for form
Mail to:
Appeals Department
MC 109
PO Box 52000
Phoenix, AZ 85072-2000
Fax: 1-855-633-7376

Oscar Garden State

Call: (844) 672-2766

To file a grievance use this form
Mail to:
Oscar Insurance
Attention Grievances
PO Box 278
New York, NY 10013

Oxford Health (United Healthcare)

Call the Customer Service number found on the member ID card.

State Regulators


Insurance Commissioner

Department of Banking and Insurance, Office of Managed Care
Chief
P.O. Box 325
Trenton, NJ 08625-0325
Phone: (609) 777-9470
Fax: (609) 633-0807

Utilization Management Appeals

Department of Banking and Insurance, Office of Managed Care
Chief
P.O. Box 325
Trenton, NJ 08625-0325
Phone: (609) 777-9470
Fax: (609) 633-0807

External Review Appeals

Department of Banking and Insurance, Office of Managed Care
Chief
P.O. Box 325
Trenton, NJ 08625-0325
Phone: (609) 777-9470
Fax: (609) 633-0807

Parity Appeals

Department of Banking and Insurance, Office of Managed Care
Chief
P.O. Box 325
Trenton, NJ 08625-0325
Phone: (609) 777-9470
Fax: (609) 633-0807

Additional New Jersey 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

 

Questions


If you have any additional questions about parity compliance, please contact info@paritytrack.org