Parity FAQ for Addiction and Mental Health Consumers

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Texas 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 Texas.

Texas Health and Human Services Commission
Resolution Services-H-6100
1100 W 49th Street
Austin, TX 78756-3168

Notifying the Consumer of the Appeals Process

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 Texas Health Plans:

BlueCross BlueShield of Texas

File a complaint by phone: 888-292-4480

Submit a complaint by mail:
Blue Cross and Blue Shield of Texas
PO Box 684249
Austin, TX 78768

To file an appeal send to:
Attn: Complaints and Appeals Unit
Blue Cross and Blue Shield of Texas
PO Box 684249
Austin, TX 78768

CHRISTUS Health

Appeals and Grievance Information

Send to:
CHRISTUS Health Plan
Attn: Appeal and Grievance Dept.
PO Box 169009
Irving, TX 75016
Fax: (866) 416-2840

Community First

Call Member Services department: 210-358-6262 or 800-434-2347

Complaint form found here

Complaint forms submit to:
Attn: Member Services Resolution Unit
12238 Silicon Drive, Suite 100
San Antonio, TX 78249

FirstCare

Call Customer Service: 800-431-7798 or 877-639-2447

IdealCare/Sendero Health Plans

Call Customer Service: 888-643-3251

Appeals submit to:
Sendero Health Plans
ATTN: Sendero Reconsiderations
PO Box 3869
Corpus Christi, TX 78463

Molina Health Care

Call Member Services: 866-449-6849 ext 752054

In writing send to:
Molina Healthcare of Texas
Attn: Member Complaints & Appeals
PO Box 165089
Irving, TX 75016

Oscar Health

For assistance call 855-672-2755

Grievance/Complaint Form

Scott & White Health Plan

Call Customer Service: 800-321-7947

United Healthcare

Call the Customer Service number on the member ID card

 

State Regulators


Insurance Commissioner

Texas Department of Insurance
Commissioner
P.O. Box 149104
Austin, TX 78714-9104
Toll Free: (800) 578-4677
Phone: (512) 676-6000
Fax: (512) 490-1045

Utilization Management Appeals

Texas Department of Insurance, MCQA Office
Director
333 Guadalupe Street
Austin, TX 78701
Phone: (512) 322-4266
Fax: (512) 490-1013

External Review Appeals

Texas Department of Insurance
333 Guadalupe Street
Austin, TX 78701
Phone: (512) 676-6401

Parity Appeals

Texas Department of Insurance, MCQA Office
Director
333 Guadalupe Street
Austin, TX 78701
Phone: (512) 322-4266
Fax: (512) 490-1013

Additional Texas 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.

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