Parity FAQ for Addiction and Mental Health Consumers

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Tennessee 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 Tennessee.

Attorney General
For information regarding filing a complaint, click here.

TennCare
Hotline for assistance: 866-311-4287
 How to file a medical appeal

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 Tennessee Health Plans:

Aetna

How to file a suggestion, complaint or grievance.

Aetna External Review Program

BlueCross  BlueShield of Tennessee

Call Member Service at the number on the member ID card

Appeals form for TennCare Medical Appeal found here
Mail to:
TennCare Solutions
PO Box 593
Nashville, TN 37202-0593

CIGNA

Contact Customer Service Department at the number on the back of member ID card

Customer Appeal Request form found here
Mail completed forms to:
Cigna Appeals Unit
PO Box 188011
Chattanooga, TN 37422

If GWH-Cigna Network mail to:
Great West Healthcare
PO Box 668
Kennett, MO 63857

Humana

Contact Member Services at the number found on the back of the member ID card

Humana Grievances and Appeals
PO Box 14165
Lexington, KY 40512-4165
Fax: 800-949-2961

Farm Bureau Health Plans/TRH Health Plans

Complete Request for Reconsideration of Declined Coverage form found here

Mail completed form to:
Farm Bureau Health Plans
Attention: Underwriting Department
PO Box 313
Columbia, TN 38402-0313

Grievance form found here
Mail completed form to:
UMR
Attention: Claims Appeal Unit
PO Box 30546
Salt Lake City, UT 84130-0546

United Healthcare

Call the Customer Service number found on the member ID card

 

State Regulators


Insurance Commissioner

Tennessee Department of Commerce & Insurance
Commissioner, Commerce & Insurance
Davy Crockett Tower, Twelfth Floor
500 James Robertson Parkway
Nashville, Tennessee 37243-0565
Toll Free: (800) 342-4029
Phone: (615) 741-6007
Fax: (615) 532-6934

Utilization Management Appeals

Department of Commerce and Insurance, Insurance Division, Life and Health Unit
Director, Policy Analysis Section, Life and Health Unit
500 James Robertson Parkway
Davy Crockett Tower, Suite 500
Nashville, TN 37243
Phone: (615) 741-2825
Fax: (615) 741-0648

External Review Appeals

Department of Commerce and Insurance, Insurance Division, Life and Health Unit
Director, Policy Analysis Section, Life and Health Unit
500 James Robertson Parkway
Davy Crockett Tower, Suite 500
Nashville, TN 37243
Phone: (615) 741-2825
Fax: (615) 741-0648

Parity Appeals

Department of Commerce and Insurance, Insurance Division, Life and Health Unit
Director, Policy Analysis Section, Life and Health Unit
500 James Robertson Parkway
Davy Crockett Tower, Suite 500
Nashville, TN 37243
Phone: (615) 741-2825
Fax: (615) 741-0648

Additional Tennessee Insurance Admininstration 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