Parity FAQ for Addiction and Mental Health Consumers

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Washington 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 Washington.

Office of the Insurance Commissioner

https://www.insurance.wa.gov/your-insurance/health-insurance/

Washington Autism Alliance & Advocacy
16225 NE 87th St. Suite A-2
Redmond, WA 98052

Key contact: Mira Posner

Redmond Offices
Phone: 425.894.7231
Spokane Office
Phone: 509-598-3413
Yakima Office
Contact: Erin Deery
Email: Erin@WashingtonAutismAdvocacy.org
Vancouver Office
Phone: 360-514-8365

http://www.washingtonautismadvocacy.org/updates/

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 Washington Health Plans:

Asuris Northwest Health

Appeals can be initiated through either written or verbal request. To initiate an appeal, consult the benefit booklet, or call or write.

Information regarding Grievances, Coverage Decisions and Appeals

Bridge Span Health

Call Member Services: 855-857-9944

Written appeals send to:
BridgeSpan Health
PO Box4208
Portland, OR 97208-4208

Community Health Plan

Call Customer Service: 800-440-1561

To file a grievance by mail send to:
Community Health Plan of Washington
Attention: Customer Service
720 Olive Way, Suite 300
Seattle, WA 98101

Coordinated Care

Call Member Services: 877-644-4613

Member Grievance Form found here or write a letter and send to:
Grievance Department
1145 Broadway, Suite 300
Tacoma, WA 98402

Kaiser Permanente

Call Membership Services

To file an appeal: form found here

Grievances can be submitted orally: call 800-813-2000
In writing send to:
Member Relations
Kaiser Permanente
500 NE Multnomah St, Suite 100
Portland, OR 97232

LifeWise Health Plan of Washington

Call Customer Service: 800-592-6804

Written requests send to:
LifeWise Health Plan of Washington
PO Box 91059
Seattle, WA 98111-9159

Molina Healthcare

Call Member Services: 800-869-7165

Send written grievance to:
Molina Healthcare
Attention: Member Appeals
PO Box 4004
Bothell, WA 98041-4004
Email: wamemberservices@molinahealthcare.com

Premera Blue Cross

Call Customer Service: 800-722-1471

To file an appeal: form found here
Mail form to:
Premera Blue Cross
Member Appeals Department
PO Box 91102
Seattle, WA 98111-9202

Regence Blue Shield

Call Member Services: 800-365-3155

Appeal form found here
Mail forms to:
Regence BlueCross BlueShield of Oregon
Attn: Regence Level 1 Member Appeals
PO Box 4208
Portland, OR 97208-4208

United Healthcare

Call Member Services at the number on the member ID card

 

State Regulators


Insurance Commissioner

Washington State Office of the Insurance Commissioner
Commissioner
Mailing:
P.O. Box 40256
Olympia, Washington 98504-0256
Physical:
500 Capitol Boulevard, SE
Tumwater, Washington 98501
Toll Free: (800) 562-6900
Phone: (360) 725-7000
Fax: (360) 586-3535
http://www.insurance.wa.gov/

Utilization Management Appeals

Washington State Office of the Insurance Commissioner
Commissioner
Mailing:
P.O. Box 40256
Olympia, Washington 98504-0256
Physical:
500 Capitol Boulevard, SE
Tumwater, Washington 98501
Toll Free: (800) 562-6900
Phone: (360) 725-7000
Fax: (360) 586-3535

External Review Appeals

Washington State Department of Health
Policy Coordinator
Mailing:
P.O. Box 40256
Olympia, Washington 98504-0256
Physical:
500 Capitol Boulevard, SE
Tumwater, Washington 98501
Phone: (360) 236-4612
iro@doh.wa.gov

Parity Appeals

Washington State Office of the Insurance Commissioner
Commissioner
Mailing:
P.O. Box 40256
Olympia, Washington 98504-0256
Physical:
500 Capitol Boulevard, SE
Tumwater, Washington 98501
Toll Free: (800) 562-6900
Phone: (360) 725-7000
Fax: (360) 586-3535

Additional Washington 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