Parity FAQ for Addiction and Mental Health Consumers

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Pennsylvania 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 Pennsylvania.

Pennsylvania Health Law Project
877-570-3642
http://www.phlp.org/home-page/about

Mental Health Association of Southeastern Pennsylvania
Alyssa Schatz or Adam Nester
1211 Chestnut Street
Philadelphia, PA 19107
Monday – Sunday 9a-5p
267-507-3340
mhequity@mhasp.org

 

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 Pennsylvania Health Plans:

Aetna

Contact Member Service phone number on member ID card

Member Complaint and Appeal Form found here

Send written request to
Aetna
PO Box 14463
Lexington, KY 40512

Capital BlueCross

Customer Service: (805) 505-2583

Contact email form

Member Appeal Form found here
Mail appeal form to:
Member Appeals Department
Capital BlueCross
PO Box 779518
Harrisburg, PA 17177-9518
Fax: (717) 541-6915

Geisinger Health Plan

Call Member Services: 800-498-9731

Coverage decisions and appeals information found here.

Written appeals send to:
Geisinger Gold
Appeal Department
100 North Academy Avenue
Danville, PA 17822-3220

Highmark Blue Cross Blue Shield

Customer Service number found on the member ID card.

Independence BlueCross

Member Services: (800) 275-2583 or call the number on the back of the member ID card

United Healthcare

Contact Member Services at the number on the member ID card

UPMC Health Plan

Member Services Department: (888) 876-2756

Information regarding Complaint and Grievance Process can be found here

Written complaints send to:
UPMC Health Plan
PO Box 2939
Pittsburgh, PA 15230-2939

 

State Regulators


 

Insurance Commissioner

Pennsylvania Insurance Department
Insurance Commissioner
1209 Strawberry Square
Harrisburg, PA 17120
(877) 881-6388
Fax: (717) 787-8585

Utilization Management Appeals

Pennsylvania Department of Health, Bureau of Managed Care
Director, Division of Certification
Health & Welfare Building
625 Forster Street, Room 912
Harrisburg, PA 17120-0701
(717) 787-5193
Fax: (717) 705-0947

External Review Appeals

Pennsylvania Department of Health Care Administration, Division of Quality Review
Nursing Services Consultant
30 North Street
Harrisburg, PA 17101
(717) 787-5193

Parity Appeals

Pennsylvania Department of Health, Bureau of Managed Care
Director, Division of Certification
Health & Welfare Building
625 Forster Street, Room 912
Harrisburg, PA 17120-0701
(717) 787-5193
Fax: (717) 705-0947

Additional Pennsylvania 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