Parity FAQ for Addiction and Mental Health Consumers

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Virginia 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 Virginia.

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

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 Virginia Health Plans:

Aetna

Call Member Service on the member ID card

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

Health Keepers (Anthem)

Call Member Services: 855-817-5787

Complaints, appeals and grievances can be written and sent to:
Complaints, Appeals and Grievances
HealthKeepers, Inc
PO Box 61116
Virginia Beach, VA 23466-1599

CareFirst BlueCross BlueShield

Call the Member Services number on the member ID card

Written complaints and appeals can be sent to the address on the member ID card

Coventry

Call the Customer Service number on the ID card

Written complaints or grievances send to:
Southern Health Services, Inc
Attention: Customer Service Department
PO Box 7135
London, KY 40742

Written appeals send to:
Southern Health Services, Inc
Attention: Appeal Coordinator
9881 Mayland Drive
Richmond, VA 23233

Innovation Health Insurance

Call the Member Service number on the digital member ID card

Kaiser Mid-Atlantic

Call Customer Service: 800-777-7902

Written communications send to:
Kaiser Permanente
Member Services Correspondence Unit
2101 East Jefferson Street
Rockville, MD 20852

Optima Health Plan

Contact Member Services at the number listed on the ID card or if no ID card call 877-552-7401

To submit an appeal send to:
Optima Health
Appeals Department
PO Box 62876
Virginia Beach, VA 23466-2876

Piedmont Community Healthcare

For medical grievances and appeals call: 434-947-3671 or 877-210-1719

A grievance or appeal may be submitted in writing here:
Piedmont Medicare Advantage
Grievances/Appeals Dept
1937 Thompson Drive
Lynchburg, VA 24501

United Healthcare

Call the Member Service number on the member ID card

 

State Regulators


Insurance Commissioner

Virginia State Corporation Commission, Bureau of Insurance
Commissioner
Mailing:
P.O. Box 1157
Richmond, VA 23218
Physical:
1300 East Main Street
Richmond, VA 23219
Toll Free: (800) 552-7945
Phone: (804) 371-9741
Fax: (804) 371-9873
bureauofinsurance@scc.virginia.gov

Utilization Management Appeals

Virginia Department of Health, Office of Licensure and Certification
Director
9960 Maryland Drive, Suite 401
Richmond, VA 23233-1485
Phone: (804) 367-2102
Fax: (804) 367-2149
inquiries@vdh.virginia.gov

External Review Appeals

Virginia Bureau of Insurance, External Review
Manager
Tyler Building
1300 E. Main Street
Richmond, VA 23219
Phone: (804) 371-9913

Parity Appeals

Virginia Department of Health, Office of Licensure and Certification
Director
9960 Maryland Drive, Suite 401
Richmond, VA 23233-1485
Phone: (804) 367-2102
Fax: (804) 367-2149

 

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