Parity FAQ for Addiction and Mental Health Consumers

or

Oregon 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 Oregon.

Department of Consumer and Business Services

Insurance help call 888-877-4894

Complaint forms, click here.
http://www.oregon.gov/DCBS/Insurance/gethelp/Pages/fileacomplaint.aspx

 

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 Oregon Health Plans:

Atrio Health Plans

Customer Service: (877) 672-8620

Grievance and Appeals information, click here
Appeals Request Form found here
Mail completed form to:
ATRIO Health Plans
2270 NW Aviation Drive, Suite 3
Roseburg, OR 97470
Fax: 866-339-8751

BridgeSpan Health

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

Appeals:
BridgeSpan Health
PO Box 4208
Portland, OR 97208-4208
Appeals fax: 888-496-1542

Health Net of Oregon

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

Kaiser Permanente

Member Services: (800) 777-7902

LifeWise Health Plan of Oregon

Customer Services: (800) 596-3440

Member Appeal Form found here
Mail completed form to:
LifeWise Health Plan of Oregon
Member Appeals Department
PO Box 91102
Seattle, WA 98111-9202
Fax: (425) 918-5592

Oregon Health CO-OP

Customer Service (844) 509-4676
customerservice@ohcoop.org

Written Appeals mail to:
Oregon’s Health CO-OP
Attn: Claim Appeals Coordinator
PO Box 40087
Portland, OR 97240

Fax: 503-416-8103

Providence Health Plan

Call Member Service at the number  on the member ID card

Medicare Advantage Plans grievance and appeals information click here

PacificSource Health Plans

Call Customer Service: (888) 977-9299

Write to:
PacificSource
Attn: Grievance Review
PO Box 7068
Springfield, OR 97475-0068
Email: lc@pacificsource.com “Grievance” as subject
Fax: (541) 225-3628

Regence Blue Cross Blue Shield of Oregon

Customer Service: (800) 365-3155

Appeal form found here
Mail form to:
Regence BlueCross BlueShield of Oregon
Attn: Regence Level 1 Member Appeals
PO Box 4208
Portland, OR 97208-4208
Fax: (888) 496-1542

Trillium Community Health Plan

Member Services: (844) 867-1156

Written appeals and grievances mail to:
Trillium Community Health Plan
Attn: Appeals and Grievances Medicare Operations
7700 Forsyth Blvd
Saint Louis, MO 63105

 

 

State Regulators


 

Insurance Commissioner

Oregon Department of Consumer and Business Services, Insurance Division
Commissioner of Insurance
350 Winter Street, NE
P.O. Box 14480
Salem, OR 97301
(503) 947-7268 or (503) 947-7276
Fax: (503) 378-4351

Utilization Management Appeals

Oregon Department of Consumer and Business Services, Insurance Division
Consumer Advocate Liaison
350 Winter Street, NE
P.O. Box 14480
Salem, OR 97301
(503) 947-7268 or (503) 947-7276
Fax: (503) 378-4351

External Review Appeals

Oregon Department of Consumer and Business Services, Insurance Division
Consumer Advocate Liaison
350 Winter Street, NE
P.O. Box 14480
Salem, OR 97301
(503) 947-7268 or (503) 947-7276
Fax: (503) 378-4351

Parity Appeals

Oregon Department of Consumer and Business Services, Insurance Division
Commissioner of Insurance
350 Winter Street, NE
P.O. Box 14480
Salem, OR 97301
(503) 947-7268 or (503) 947-7276
Fax: (503) 378-4351

Additional Oregon 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